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Mohammed S, Calvert C, O Mugisha J, Ronald M, Asiki G, R Glynn J, Oakley LL, Marston M. Association between breastfeeding duration and educational attainment in rural Southwest Uganda: a population-based cohort study. Glob Health Action 2024; 17:2338023. [PMID: 38652548 DOI: 10.1080/16549716.2024.2338023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Breastfeeding is important for early childhood nutrition and health. The positive effects on educational outcomes may be attributed to socioeconomic factors. Socioeconomic status is not a strong predictor of breastfeeding in sub-Saharan African countries. Yet, few studies have investigated the association between breastfeeding and educational outcomes in these countries. OBJECTIVE This study investigated the association between breastfeeding duration and children's educational attainment in rural Southwest Uganda. METHODS We analysed longitudinal data on 3018 children who had information on breastfeeding and were followed for at least 5 years, with at least one primary school grade recorded by 2005. Data on breastfeeding duration were collected from mothers. The highest school grade was recorded repeatedly between ages 6 and 12 years. We calculated age-for-grade based on whether a child was on, over, or under the official age for a grade. Generalised estimating equations and binary logistic regression estimated the effect of breastfeeding duration on being 2 years, 3 or more years, or any years over-age for grade in primary school, adjusting for socioeconomic status and maternal-child characteristics. RESULTS Most mothers breastfed for more than a year. Just over one-third breastfed for 18-23 months, and 30% breastfed for longer. By age eight, 42% of the children were two years over-age for their grade. Three or more years over-age for grade increased from 19% at age nine to 56% at age 12. Both adjusted and unadjusted estimates were consistent in showing reduced odds for children being 2 years, 3 or more years, or any years over-age for grade among children breastfed for 7-12, 13-17, 18-23, and > 23 months compared to those breastfed for 0-6 months. There was no evidence to support an overall association between breastfeeding duration and being over-age for grade. There was no evidence of association in the sex and age sub-group analyses. CONCLUSION Although we found no association between breastfeeding duration and educational attainment, breastfeeding remains important for children's health and nutrition, and mothers should be encouraged and supported to breastfeed for the recommended duration.
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Affiliation(s)
- Shamsudeen Mohammed
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Makanga Ronald
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Gershim Asiki
- African Population and Health Research Center (APHRC), Nairobi, Uganda
| | - Judith R Glynn
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Laura L Oakley
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Milly Marston
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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De Souza J, Viswanath VK, Echterhoff JM, Chamberlain K, Wang EJ. Augmenting Telepostpartum Care With Vision-Based Detection of Breastfeeding-Related Conditions: Algorithm Development and Validation. JMIR AI 2024; 3:e54798. [PMID: 38913995 DOI: 10.2196/54798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/20/2024] [Accepted: 05/09/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Breastfeeding benefits both the mother and infant and is a topic of attention in public health. After childbirth, untreated medical conditions or lack of support lead many mothers to discontinue breastfeeding. For instance, nipple damage and mastitis affect 80% and 20% of US mothers, respectively. Lactation consultants (LCs) help mothers with breastfeeding, providing in-person, remote, and hybrid lactation support. LCs guide, encourage, and find ways for mothers to have a better experience breastfeeding. Current telehealth services help mothers seek LCs for breastfeeding support, where images help them identify and address many issues. Due to the disproportional ratio of LCs and mothers in need, these professionals are often overloaded and burned out. OBJECTIVE This study aims to investigate the effectiveness of 5 distinct convolutional neural networks in detecting healthy lactating breasts and 6 breastfeeding-related issues by only using red, green, and blue images. Our goal was to assess the applicability of this algorithm as an auxiliary resource for LCs to identify painful breast conditions quickly, better manage their patients through triage, respond promptly to patient needs, and enhance the overall experience and care for breastfeeding mothers. METHODS We evaluated the potential for 5 classification models to detect breastfeeding-related conditions using 1078 breast and nipple images gathered from web-based and physical educational resources. We used the convolutional neural networks Resnet50, Visual Geometry Group model with 16 layers (VGG16), InceptionV3, EfficientNetV2, and DenseNet169 to classify the images across 7 classes: healthy, abscess, mastitis, nipple blebs, dermatosis, engorgement, and nipple damage by improper feeding or misuse of breast pumps. We also evaluated the models' ability to distinguish between healthy and unhealthy images. We present an analysis of the classification challenges, identifying image traits that may confound the detection model. RESULTS The best model achieves an average area under the receiver operating characteristic curve of 0.93 for all conditions after data augmentation for multiclass classification. For binary classification, we achieved, with the best model, an average area under the curve of 0.96 for all conditions after data augmentation. Several factors contributed to the misclassification of images, including similar visual features in the conditions that precede other conditions (such as the mastitis spectrum disorder), partially covered breasts or nipples, and images depicting multiple conditions in the same breast. CONCLUSIONS This vision-based automated detection technique offers an opportunity to enhance postpartum care for mothers and can potentially help alleviate the workload of LCs by expediting decision-making processes.
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Affiliation(s)
- Jessica De Souza
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Varun Kumar Viswanath
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Jessica Maria Echterhoff
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Kristina Chamberlain
- Division of Extended Studies, University of California, San Diego, La Jolla, CA, United States
| | - Edward Jay Wang
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA, United States
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3
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Den Besten-Bertholee D, Touw DJ, Damer EA, Mian P, Ter Horst PGJ. Sertraline, citalopram and paroxetine in lactation: passage into breastmilk and infant exposure. Front Pharmacol 2024; 15:1414677. [PMID: 38841362 PMCID: PMC11150716 DOI: 10.3389/fphar.2024.1414677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
Objectives This study aimed to investigate the plasma and breastmilk concentrations for sertraline, citalopram and paroxetine for assessment of the Milk/Plasma (M/P) ratio and Absolute Infant Dose (AID), and to determine actual infant drug exposure through breastfeeding. Subsequently, informed recommendations will be formulated regarding the advisability of breastfeeding in women undergoing treatment with the three most widely used antidepressants. Methods A pharmacokinetic study in lactating women and their infants using sertraline, citalopram or paroxetine was performed. Paired breastmilk and plasma samples and single point infant plasma samples were collected to determine antidepressant concentrations. An Area Under the Curve (AUC) based approach with the trapezoidal rule was used to calculate M/P ratios and AID for all three antidepressants by combining all measured concentrations for the same dose. Results Thirty-seven lactating women and their infants participated in this study. 111 paired breastmilk and plasma samples and 37 single point infant plasma samples were collected. Detectable concentrations of sertraline, citalopram and paroxetine were present in all breastmilk samples. For sertraline and citalopram M/P ratio is above one, indicating higher breastmilk than plasma concentrations, however, drug exposure by breastmilk did not lead to detectable plasma drug levels in any of the 15 infants for sertraline, for nine (out of 13) infants for citalopram and for eight (out of nine) infants for paroxetine. Conclusion Given the well-known benefits of breastfeeding, our findings support breastfeeding of infants by mothers who are taking sertraline, citalopram or paroxetine is safe. Sertraline and paroxetine are the preferred antidepressants during breastfeeding, reaching mostly undetectable infant drug levels.
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Affiliation(s)
| | - Daan J. Touw
- Groningen Research Institute of Pharmacy, Section Pharmaceutical Analysis, University of Groningen, Groningen, Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | | | - Paola Mian
- Groningen Research Institute of Pharmacy, Section Pharmaceutical Analysis, University of Groningen, Groningen, Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
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Rattay K, Robinson LR. Identifying Risk Factors for Attention-Deficit/Hyperactivity Disorder (ADHD): a Public Health Concern and Opportunity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:195-202. [PMID: 38598041 DOI: 10.1007/s11121-024-01667-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders with significant individual and societal negative impacts of the disorder continuing into adulthood (Danielson et al. in Journal of Clinical Child and Adolescent Psychology, in press; Landes and London in Journal of Attention Disorders 25:3-13, 2021). Genetic and environmental risk (e.g., modifiable exposures such as prenatal tobacco exposure and child maltreatment) for ADHD is likely multifactorial (Faraone et al. in Neuroscience & Biobehavioral Reviews 128:789-818, 2021). However, the evidence for potentially modifiable contextual risks is spread across studies with different methodologies and ADHD criteria limiting understanding of the relationship between early risk factors and later childhood ADHD. Using common methodology across six meta-analyses (Bitsko et al. in Prevention Science, 2022; Claussen et al. in Prevention Science 1-23, 2022; Dimitrov et al. in Prevention Science, 2023; Maher et al. in Prevention Science, 2023; Robinson, Bitsko et al. in Prevention Science, 2022; So et al. in Prevention Science, 2022) examining 59 risk factors for childhood ADHD, the papers in this special issue use a public health approach to address prior gaps in the literature. This introductory paper provides examples of comprehensive public health approaches focusing on policy, systems, and environmental changes across socio-ecological contexts to improve health and wellbeing through prevention, early intervention, and support across development using findings from these meta-analyses. Together, the findings from these studies and a commentary by an author independent from the risk studies have the potential to minimize risk conditions, prioritize prevention efforts, and improve the long-term health and wellbeing of children and adults with ADHD.
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Affiliation(s)
- Karyl Rattay
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Lara R Robinson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention, Atlanta, GA, USA
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5
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Bridgman SL, Penfold S, Field CJ, Haqq AM, Mandhane PJ, Moraes TJ, Turvey SE, Simons E, Subbarao P, Kozyrskyj AL. Pre-labor and post-labor cesarean delivery and early childhood adiposity in the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study. Int J Obes (Lond) 2024; 48:717-724. [PMID: 38302592 DOI: 10.1038/s41366-024-01480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND/OBJECTIVES Delivery by cesarean section (CS) compared to vaginal delivery has been associated with increased risk of overweight in childhood. Our study examined if the presence or absence of labor events in CS delivery altered risk of overweight in early childhood (1-5 years) compared to vaginal delivery and if this association differed according to infant sex. SUBJECTS/METHODS The study included 3073 mother-infant pairs from the CHILD Cohort Study in Canada. Data from birth records were used to categorize infants as having been vaginally delivered, or delivered by CS, with or without labor events. Age and sex adjusted weight-for-length (WFL) and body mass index (BMI) z scores were calculated from height and weight data from clinic visits at 1, 3 and 5 years and used to classify children as overweight. Associations between delivery mode and child overweight at each timepoint were assessed using regression models, adjusting for relevant confounding factors including maternal pre-pregnancy BMI. Effect modification by infant sex was tested. RESULTS One in four infants (24.6%) were born by CS delivery; 13.0% involved labor events and 11.6% did not. Infants born by CS without labor had an increased odds of being overweight at age 1 year compared to vaginally delivered infants after adjustment for maternal pre-pregnancy BMI, maternal diabetes, smoking, infant sex and birthweight-for-gestational age (aOR 1.68 [95% CI 1.05-2.67]). These effects did not persist to 3 or 5 years of age and, after stratification by sex, were only seen in boys (aOR at 1 year 2.21 [95% CI 1.26-3.88]). CONCLUSION AND RELEVANCE Our findings add to the body of evidence that CS, in particular CS without labor events, may be a risk factor for overweight in early life, and that this association may be sex-specific. These findings could help to identify children at higher risk for developing obesity.
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Affiliation(s)
- Sarah L Bridgman
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
- London School of Hygiene and Tropical Medicine, University of London, London, UK.
| | - Suzanne Penfold
- London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Catherine J Field
- Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Department of Agriculture, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada
| | | | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | - Elinor Simons
- Manitoba Interdisciplinary Lactation Centre, Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Padmaja Subbarao
- Department of Pediatrics and Physiology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Guerrero CH, Cremades R, Sierra-Diaz E, López Flores MDL, Murcia-Baquero LM, Sandoval-Pinto E. Association of Food Security With Breastfeeding Practices: A Scoping Review. Cureus 2024; 16:e61177. [PMID: 38933626 PMCID: PMC11205263 DOI: 10.7759/cureus.61177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Breastfeeding is the fundamental, physiological, and psychosocial process by which the mother feeds the newborn. Early initiation of breastfeeding is recommended within the first hour of life and exclusive breastfeeding up to six months of age due to its optimal contribution of nutrients for the development of the newborn. Despite this, there are factors that affect this process which involve the nutritional, physical, and psychological state of the mother, such as food security or food insecurity, however, it is unknown if it will have a decisive impact on these factors concerning the cessation of breastfeeding or total duration of breastfeeding. This study is an in-depth review of the available information related to food security as a determinant in breastfeeding practices. We did a scoping review between December 2022 - January 2023. The principal inclusion criteria were: the use of the English language, qualitative and quantitative methods, and analytical studies. All the articles were available in full text and the manuscripts ranged from 1997 and 2022. Twelve studies were included: eight quantitative, two qualitative, and two mixed. In the quantitative studies, significant positive and negative associations were found between food insecurity, exclusive breastfeeding, early initiation of breastfeeding, cessation of breastfeeding, and total duration of breastfeeding. For their part, qualitative and mixed studies describe that women with severe food insecurity tend to feel weak and may have a poor perception of their diet and, consequently, their breastfeeding practices are lower. Moreover, there are qualitative studies that mention that the higher the food insecurity, the more frequently breastfeeding occurs. The inconsistency in the results may be due to factors involving the characteristics of each population, the instrument used to measure food security, and the variables by which the models were adjusted. It is necessary to carry out more studies on the subject since it is obvious that the relationship between the variables needs to be clarified.
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Affiliation(s)
- Christian H Guerrero
- Centro Universitario de Ciencias de la Salud, Departamento de Salud Pública, Universidad de Guadalajara, Guadalajara, MEX
| | - Rosa Cremades
- Centro Universitario de Ciencias de la Salud, Departamento de Microbiología y Patología, Universidad de Guadalajara, Guadalajara, MEX
| | - Erick Sierra-Diaz
- Centro Universitario de Ciencias de la Salud, Departamento de Salud Pública, Universidad de Guadalajara, Guadalajara, MEX
| | - María de Lourdes López Flores
- Centro Universitario de Ciencias de la Salud, Departamento de Salud Pública, Universidad de Guadalajara, Guadalajara, MEX
| | - Lina María Murcia-Baquero
- Centro Universitario de Ciencias de la Salud, Departamento de Salud Pública, Universidad de Guadalajara, Guadalajara, MEX
| | - Elena Sandoval-Pinto
- Centro Universitario de Ciencias Biológicas y Agropecuarias, Departamento de Biología Celular y Molecular, Universidad de Guadalajara, Guadalajara, MEX
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Suteerojntrakool O, Mekangkul E, Maitreechit D, Khabuan S, Sodsai P, Hirankarn N, Thumbovorn R, Chomtho S. Preservation of Anti-SARS-CoV-2 Neutralizing Antibodies in Breast Milk: Impact of Maternal COVID-19 Vaccination and Infection. Breastfeed Med 2024; 19:340-348. [PMID: 38506333 DOI: 10.1089/bfm.2023.0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Objectives: To investigate specific immunoglobulin A (sIgA), specific immunoglobulin G (sIgG), and neutralizing antibodies (NAbs) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in breast milk and compare immunity in mothers with hybrid immunity (infection and vaccination) versus those solely vaccinated (coronavirus disease [COVID]-naïve). Methods: A longitudinal study was conducted among lactating mothers who received at least two doses of the coronavirus disease 2019 (COVID-19) vaccine or tested positive for SARS-CoV-2. Details of vaccination and infection were collected through questionnaires and interviews. Fifteen milliliters of breast milk samples, self-collected at 1, 3, and 6 months postvaccination or infection, were sent to analysis for sIgA, sIgG, and NAbs using enzyme-linked immunosorbent assay. Results: In total, 119 lactating mothers (202 milk samples) were enrolled; 82 participants had hybrid immunity, and 32 were COVID-19-naïve. Two-thirds received a combination of different vaccines and booster shots. Breast milk retained sIgA, sIgG, and NAbs for up to 6 months post-COVID vaccination or infection. At 3 months, mothers with hybrid immunity had significantly higher sIgA and NAbs compared with COVID-naïve mothers (geometric mean [95% confidence interval (CI)] of sIgA 2.72 [1.94-3.8] vs. 1.44 [0.83-2.48]; NAbs 86.83 [84.9-88.8] vs. 81.28 [76.02-86.9]). No differences in sIgA, sIgG, and NAbs were observed between lactating mothers receiving two, three, or more than or equal to three doses, regardless of hybrid immunity or COVID-naïve status. Conclusion: sIgA, sIgG, and NAbs against SARS-CoV-2 in breast milk sustained for up to 6 months postimmunization and infection. Higher immunity was found in mothers with hybrid immunity. These transferred immunities confirm in vitro protection, supporting the safety of breastfeeding during and after COVID-19 vaccination or infection.
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Affiliation(s)
- Orapa Suteerojntrakool
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Ambulatory Division, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Eakkarin Mekangkul
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Nutrition, Department of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | | | - Siriporn Khabuan
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pimpayao Sodsai
- Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nattiya Hirankarn
- Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rungtip Thumbovorn
- Department of Microbiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Sirinuch Chomtho
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Smith AE, Sweigart E, Falatic K, Stuart D, Szugye H, Lam SK, Aly H, Das A. Direct breastfeeding frequency of late preterm and term infants in the neonatal intensive care unit and availability of mother's own milk at six months of age. a retrospective cohort study. J Perinatol 2024:10.1038/s41372-024-01972-w. [PMID: 38678083 DOI: 10.1038/s41372-024-01972-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/01/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Mother's Own Milk (MOM) reduces the risk of complications in premature infants. Breastfeeding rates for late preterm and term infants in the neonatal intensive care unit (NICU) are significantly lower than that of breastfed healthy term newborns at 6 months of age. DESIGN This was a retrospective cohort study of neonates born at 34 weeks 0 days or later. Infants who were directly breastfed in the NICU and were discharged on breast milk were included. Logistic regression modeling was used to determine the significance of association. RESULTS 171 mother-infant dyads were included. After adjusting for confounders, the number of breastfeeding attempts during the NICU stay was significantly associated with the availability of MOM at six months of age (p = 0.003, 95% CI 1.02 to 1.14). CONCLUSION This study is the first to show an association between the number of direct breastfeeding attempts in the NICU and availability of MOM at six months of age.
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Affiliation(s)
- Amanda E Smith
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
| | - Erin Sweigart
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Kimberly Falatic
- Department of Childbirth Education, Cleveland Clinic, Cleveland, OH, USA
| | - Dena Stuart
- Department of Childbirth Education, Cleveland Clinic, Cleveland, OH, USA
| | - Heidi Szugye
- Breastfeeding Medicine, Department of Primary Care Pediatrics, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Suet Kam Lam
- Breastfeeding Medicine, Department of Primary Care Pediatrics, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Anirudha Das
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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van der Louw E, Trimmel-Schwahofer P, Devlin A, Armeno M, Thompson L, Cross JH, Auvin S, Dressler A. Human milk and breastfeeding during ketogenic diet therapy in infants with epilepsy: Clinical practice guideline. Dev Med Child Neurol 2024. [PMID: 38669468 DOI: 10.1111/dmcn.15928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 04/28/2024]
Abstract
Ketogenic diet therapy (KDT) is a safe and effective treatment for epilepsy and glucose transporter type 1 (GLUT1) deficiency syndrome in infancy. Complete weaning from breastfeeding is not required to implement KDT; however, breastfeeding remains uncommon. Barriers include feasibility concerns and lack of referrals to expert centres. Therefore, practical strategies are needed to help mothers and professionals overcome these barriers and facilitate the inclusion of breastfeeding and human milk during KDT. A multidisciplinary expert panel met online to address clinical concerns, systematically reviewed the literature, and conducted two international surveys to develop an expert consensus of practical recommendations for including human milk and breastfeeding in KDT. The need to educate about the nutritional benefits of human milk and to increase breastfeeding rates is emphasized. Prospective real-world registries could help to collect data on the implementation of breastfeeding and the use of human milk in KDT, while systematically including non-seizure-related outcomes, such as quality of life, and social and emotional well-being, which could improve outcomes for infants and mothers.
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Affiliation(s)
- Elles van der Louw
- Department of Internal Medicine, Division of Dietetics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Petra Trimmel-Schwahofer
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
- European Reference Network, EpiCARE
| | - Anita Devlin
- Paediatric Neurology, Great North Children's Hospital, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marisa Armeno
- Department of Nutrition, Hospital de Pediatria Prof. Dr. J.P. Garrahan, Buenos Aires, Argentina
| | - Lindsey Thompson
- Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | - J Helen Cross
- UCL NIHR BRC Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Stéphane Auvin
- European Reference Network, EpiCARE
- APHP, Service de Neurologie Pédiatrique, Hôpital Robert Debré, Paris, France
- Université Paris-Cité, INSERM Neuro Diderot, Paris, France
- Institut Universitaire de France (IUF), Paris, France
| | - Anastasia Dressler
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
- European Reference Network, EpiCARE
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10
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Michalopoulou S, Garcia AL, Wolfson L, Wright CM. Does planning to mixed feed undermine breastfeeding? MATERNAL & CHILD NUTRITION 2024; 20:e13610. [PMID: 38093405 PMCID: PMC10981487 DOI: 10.1111/mcn.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 04/01/2024]
Abstract
Continued breastfeeding is important for infants' health, but it is unclear whether mixed feeding increases the risk of breastfeeding cessation. We aimed to explore associations of mixed feeding and lactation problems with early cessation of breastfeeding. We analysed data from mothers who completed the Scottish National Maternal and Infant Feeding Survey and had previously breastfed their infants. At age 8-12 weeks, mothers (N = 1974) reported their feeding history and intentions, lactation problems and reasons for giving formula milk. The main outcome measure was cessation of breastfeeding before 6-8 weeks and time to cessation. By 6 weeks, 65% had mixed fed at some point, 32% had ceased breastfeeding, 22% were currently mixed feeding and 46% were exclusively breastfeeding. Lactation problems before 2 weeks were common (65%), and strongly associated with stopping breastfeeding (relative risk [RR]: 3.23, 95% confidence interval [CI]: 2.0-5.3) and with mixed feeding (RR: 3.14, 95% CI: 2.5-4.0). However, even after adjustment for breastfeeding problems mothers who planned to mixed feed (RR: 3.39, 95% CI: 2.4-4.9) and those who introduced formula for practicalities (RR: 3.21, 95% CI: 2.3-4.4) were more likely to stop breastfeeding. These variables also predicted later lactation insufficiency (planned mixed feeding RR: 1.39, 95% CI: 1.0-2.0; formula for practicalities RR: 1.76, 95% CI: 1.3-2.3). Mothers who received specialist lactation support were less likely to cease breastfeeding (RR: 0.63, 95% CI: 0.5-0.9) but nonspecialist input was unrelated to risk of cessation (RR: 1.06, 95% CI: 0.2-4.9). In conclusion, choosing to mix feed an infant is strongly associated with stopping breastfeeding, even in the absence of lactation problems.
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Affiliation(s)
- Stamatia Michalopoulou
- Human Nutrition, School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowScotlandUK
| | - Ada L. Garcia
- Human Nutrition, School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowScotlandUK
| | - Linda Wolfson
- Improving Health and WellbeingScottish GovernmentGlasgowScotlandUK
| | - Charlotte M. Wright
- Human Nutrition, School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowScotlandUK
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11
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Dijokienė I, Žemaitienė R, Stonienė D. Late Preterm Newborns: Breastfeeding and Complementary Feeding Practices. CHILDREN (BASEL, SWITZERLAND) 2024; 11:401. [PMID: 38671618 PMCID: PMC11049072 DOI: 10.3390/children11040401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The aim of this study is to identify factors associated with successful breastfeeding in late preterm infants (LPIs) and explore the initiation of complementary feeding; Methods: Prospective cohort study was conducted of infants born at 34+0 to 36+6 weeks gestational age in the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics during 2020-2021. Families were followed up until the infants reached 12 months of age. Average breastfeeding initial time, average breastfeeding duration time, prevalence of exclusive breastfeeding and average solid-food feeding initiation time were examined. The correlations among factors that might affect breastfeeding rates were calculated using the chi-square test (p < 0.05); Results: In our study with 222 eligible participants, we observed a statistically significant delay in breastfeeding initiation only in the 34+0+6 gestational age group (p < 0.001). At discharge, the 36+0+6 group exhibited a significantly higher exclusive breastfeeding rate (p < 0.001). Over the first year, breastfeeding rates varied, with no correlation found between duration of exclusive breastfeeding and gestational age. Initial solid-food feeding times were similar across groups, and all infants were introduced to vegetables first; Conclusions: Vaginal delivery, skin-to-skin contact after birth, early rooming-in, and breastfeeding within 2 h after birth statistically significantly causes earlier breastfeeding initiation and longer duration of breastfeeding in LPIs. All infants began solid-food feeding at an average age of 5 months, with vegetables being the primary food choice.
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Affiliation(s)
| | | | - Dalia Stonienė
- Department of Neonatology, Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (I.D.); (R.Ž.)
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12
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Thangaraj SV, Ghnenis A, Pallas B, Vyas AK, Gregg B, Padmanabhan V. Comparative lipidome study of maternal plasma, milk, and lamb plasma in sheep. Sci Rep 2024; 14:7401. [PMID: 38548847 PMCID: PMC10978966 DOI: 10.1038/s41598-024-58116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/25/2024] [Indexed: 04/01/2024] Open
Abstract
Lipids play a critical role in neonate development and breastmilk is the newborn's major source of lipids. Milk lipids directly influence the neonate plasma lipid profile. The milk lipidome is dynamic, influenced by maternal factors and related to the maternal plasma lipidome. The close inter-relationship between the maternal plasma, milk and neonate plasma lipidomes is critical to understanding maternal-child health and nutrition. In this exploratory study, lipidomes of blood and breast milk from Suffolk sheep and matched lamb blood (n = 13), were profiled on day 34 post birth by untargeted mass spectrometry. Comparative multivariate analysis of the three matrices identified distinct differences in lipids and class of lipids amongst them. Paired analysis identified 346 differential lipids (DL) and 31 correlated lipids (CL) in maternal plasma and milk, 340 DL and 32 CL in lamb plasma and milk and 295 DL and 16 CL in maternal plasma and lamb plasma. Conversion of phosphatidic acid to phosphatidyl inositol was the most active pathway in lamb plasma compared to maternal plasma. This exploratory study illustrates the partitioning of lipids across maternal plasma, milk and lamb plasma and the dynamic relationship between them, reiterating the need to study these three matrices as one biological system.
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Affiliation(s)
- Soundara Viveka Thangaraj
- Department of Pediatrics, University of Michigan, 7510 MSRB 1, 1500 W. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Adel Ghnenis
- Department of Pediatrics, University of Michigan, 7510 MSRB 1, 1500 W. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Brooke Pallas
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Arpita Kalla Vyas
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Brigid Gregg
- Department of Pediatrics, University of Michigan, 7510 MSRB 1, 1500 W. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Vasantha Padmanabhan
- Department of Pediatrics, University of Michigan, 7510 MSRB 1, 1500 W. Medical Center Drive, Ann Arbor, MI, 48109, USA.
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13
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Hatem O, Kaçar ÖF, Kaçar HK, Szentpéteri JL, Marosvölgyi T, Szabó É. Trans isomeric fatty acids in human milk and their role in infant health and development. Front Nutr 2024; 11:1379772. [PMID: 38515522 PMCID: PMC10954868 DOI: 10.3389/fnut.2024.1379772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/27/2024] [Indexed: 03/23/2024] Open
Abstract
It is well known that long chain polyunsaturated fatty acids (LCPUFAs) play an important role in neurodevelopment in the perinatal life. The most important source of these fatty acids is the diet, however, they can also be formed in the human body from their shorter chain precursors, the essential fatty acids. Since the WHO recommends exclusive breastfeeding for the first six months after birth, the exclusive source of these fatty acids for breastfed infants is human milk, which can be influenced by the mother's diet. Unsaturated fatty acids can have either cis or trans configuration double bond in their chain with distinct physiological effects. Cis isomeric unsaturated fatty acids have several beneficial effects, while trans isomers are mostly detrimental, because of their similar structure to saturated fatty acids. Trans fatty acids (TFAs) can be further subdivided into industrial (iTFA) and ruminant-derived trans fatty acids (rTFA). However, the physiological effects of these two TFA subgroups may differ. In adults, dietary intake of iTFA has been linked to atherosclerosis, insulin resistance, obesity, chronic inflammation, and increased development of certain cancers, among other diseases. However, iTFAs can have a negative impact on health not only in adulthood but in childhood too. Results from previous studies have shown that iTFAs have a significant negative effect on LCPUFA levels in the blood of newborns and infants. In addition, iTFAs can affect the growth and development of infants, and animal studies suggest that they might even have lasting negative effects later in life. Since the only source of TFAs in the human body is the diet, the TFA content of breast milk may determine the TFA supply of breastfed infants and thus affect the levels of LCPUFAs important for neurodevelopment and the health of infants. In this review, we aim to provide an overview of the TFA content in human milk available in the literature and their potential effects on infant health and development.
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Affiliation(s)
- Okba Hatem
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pécs, Pécs, Hungary
| | - Ömer Furkan Kaçar
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pécs, Pécs, Hungary
| | - Hüsna Kaya Kaçar
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Amasya University, Amasya, Türkiye
| | - József L. Szentpéteri
- Institute of Transdisciplinary Discoveries, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Marosvölgyi
- Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Éva Szabó
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pécs, Pécs, Hungary
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14
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Gerrard SD, Yonke JA, McMillan RP, Sunny NE, El-Kadi SW. Medium-Chain Fatty Acid Feeding Reduces Oxidation and Causes Panacinar Steatosis in Livers of Neonatal Pigs. J Nutr 2024; 154:908-920. [PMID: 38253226 DOI: 10.1016/j.tjnut.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Medium-chain fatty acids (MCFAs) are commonly used to enhance the caloric content of infant formulas. We previously reported that pigs fed MCFA developed hepatic steatosis when compared to those fed isocaloric long-chain fatty acid (LCFA) rich formula. OBJECTIVES The objectives of this study were to investigate: 1) whether MCFA and LCFA feeding affect hepatic fatty acid oxidation, and 2) how fat type alters the expression of hepatic fatty acid metabolic genes. METHODS Twenty-six, 7-d-old pigs were fed a low-energy control (CONT) formula, or 2 isocaloric high-energy formulas rich in LCFA or MCFA for 22 days. Livers were collected for examining ex vivo fatty acid oxidation, fatty acid content, and mRNA expression of fatty acid metabolic genes. RESULTS Liver fat was 20% for pigs in the MCFA compared with 2.9% and 4.6% for those in the CONT and LCFA groups (P < 0.05). MCFA-fed pigs had greater amounts of hepatic laurate, myristate, palmitate, and palmitoleate (14, 34, 49, and 9.3 mg · g-1) than those fed LCFA and CONT (1.8, 1.9, 19, 1.5 mg · g-1) formulas (P ≤ 0.05). Hepatic laurate and palmitate oxidation was reduced for pigs fed MCFA (29 mmol · mg-1 · h-1) compared with those fed CONT (54 mmol · mg-1 · h-1) and LCFA (51 mmol · mg-1 · h-1) formulas (P < 0.05). Expression of fatty acid synthase 3 (FASN-3), fatty acid binding protein 1 (FABP-1), and acetyl-CoA carboxylase 1 (ACACA-1) were 8-, 6-, and 2-fold greater for pigs in the MCFA than those in the LCFA and CONT groups (P < 0.05). CONCLUSIONS Feeding MCFA resulted in hepatic steatosis compared with an isocaloric formula rich in LCFA. Steatosis occurred concomitantly with reduced fatty acid oxidation but greater mRNA expression of fatty acid synthetic and catabolic genes.
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Affiliation(s)
- Samuel D Gerrard
- School of Animal Sciences, Virginia Tech, Blacksburg, VA, United States
| | - Joseph A Yonke
- School of Animal Sciences, Virginia Tech, Blacksburg, VA, United States
| | - Ryan P McMillan
- Virginia Tech Metabolic Phenotyping Core, Virginia Tech, Blacksburg, VA, United States
| | - Nishanth E Sunny
- Department of Animal and Avian Sciences, University of Maryland, College Park, MD, United States
| | - Samer W El-Kadi
- School of Animal Sciences, Virginia Tech, Blacksburg, VA, United States.
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15
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Nazareth M, Pinto E, Severo M, Graça P, Lopes C, Rêgo C. Early feeding and nutritional status of Portuguese children in the first 36 months of life: EPACI Portugal 2012-a national representative cross-sectional study. Porto Biomed J 2024; 9:250. [PMID: 38681517 PMCID: PMC11049788 DOI: 10.1097/j.pbj.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/07/2024] [Accepted: 02/21/2024] [Indexed: 05/01/2024] Open
Abstract
Background Early feeding practices have a critical role in the future not only in health but also in modulating eating habits. This study aimed to assess breastfeeding and complementary feeding practices and the nutritional status of Portuguese toddlers aged 0-36 months. Methods EPACI Portugal 2012 is a cross-sectional study of a national representative sample. Trained interviewers collected data about early feeding practices and anthropometrics. Body mass index was classified according to World Health Organization criteria. Frequencies and survival analysis were used to characterize variables. Results More than 90% of children were initiated breastfeeding, around 20% were exclusively breastfed for six months, and about 20% were breastfed at 12 months while complementary feeding was taking place. Exclusive breastfeeding was determined by maternal prepregnancy body mass index (HR 1.01; 95% CI 1.00, 1.03, P=.03) and low birth weight (HR 1.61; IC 95% 1.21, 2.15, P=.001) of the infants. About 90% were initiated complementary feeding between four and six months, and almost 10% were introduced to cow's milk before 12 months. In the second year of life, 83.2% and 61.6% of toddlers have already consumed nectars and sweet desserts, respectively. About one-third of Portuguese toddlers showed a body mass index z-score >1, and 6.6% were overweight/obese (z-score >2). No association was found between the duration of breastfeeding or timing of complementary feeding and the body mass index z-score in children. Conclusions Despite the low prevalence of exclusive breastfeeding at six months, Portuguese infants effectively comply with dietary recommendations during the first year of life. The transition to the family diet must be carefully made. There is a high prevalence of Portuguese toddlers at least at overweight risk. The duration of breastfeeding or timing of complementary feeding was not associated with the expression of overweight/obesity.
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Affiliation(s)
- Margarida Nazareth
- Universidade Católica Portuguesa, CBQF—Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - Elisabete Pinto
- Universidade Católica Portuguesa, CBQF—Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
- EPIUnit—Institute of Public Health, University of Porto, Porto, Portugal
| | - Milton Severo
- EPIUnit/ITR—Laboratory for Integrative and Translational Research in Population Health—Institute of Public Health, University of Porto, Porto, Portugal
- ICBAS—School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Pedro Graça
- EPIUnit/ITR—Laboratory for Integrative and Translational Research in Population Health—Institute of Public Health, University of Porto, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Carla Lopes
- EPIUnit/ITR—Laboratory for Integrative and Translational Research in Population Health—Institute of Public Health, University of Porto, Porto, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carla Rêgo
- Universidade Católica Portuguesa, CBQF—Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
- Child and Adolescent Centre, CUF Hospital Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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16
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Boo Gordillo P, Marqués Martínez L, Borrell García C, García Miralles E. Relationship between Nutrition and Development of the Jaws in Children: A Pilot Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:201. [PMID: 38397313 PMCID: PMC10887185 DOI: 10.3390/children11020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Craniofacial growth and development have been shown to be influenced by various environmental factors that impact child development. This study aims to analyze the different patterns of feeding during early childhood, starting from birth, and assess the variability of nutrition during the first stage of childhood, along with the habits developed, to study their impact on jaw development. The study was conducted on a sample of twenty-five patients aged 3 to 5, following approval from the ethics committee of the Catholic University of Valencia. Informed consent was obtained from the fathers, mothers, and/or legal guardians, who were administered surveys on habits and diet. Cephalometric measurements within the parameters of ideal occlusion were subsequently taken. While previous studies examined this subject, the findings are challenging to evaluate. However, this study identified significant associations (p = 0.001) between clinical measurements and children's eating habits. The growth and development of the craniofacial cavity are influenced by multiple factors, including a child's diet and habits. Nonetheless, further research is required to determine whether diet can be considered a determining factor in proper jaw growth.
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Affiliation(s)
- Paula Boo Gordillo
- Doctoral School, Faculty of Medicine and Health Sciences, Catholic University of Valencia, San Vicente Martir, 46001 Valencia, Spain;
| | - Laura Marqués Martínez
- Faculty of Medicine and Health Sciences, Catholic University of Valencia, San Vicente Martir, 46001 Valencia, Spain; (C.B.G.); (E.G.M.)
| | - Carla Borrell García
- Faculty of Medicine and Health Sciences, Catholic University of Valencia, San Vicente Martir, 46001 Valencia, Spain; (C.B.G.); (E.G.M.)
| | - Esther García Miralles
- Faculty of Medicine and Health Sciences, Catholic University of Valencia, San Vicente Martir, 46001 Valencia, Spain; (C.B.G.); (E.G.M.)
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17
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Hörnell A, Lagström H. Infant feeding-a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2024; 68:10456. [PMID: 38370110 PMCID: PMC10870977 DOI: 10.29219/fnr.v68.10456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 12/11/2022] [Accepted: 12/20/2023] [Indexed: 02/20/2024] Open
Abstract
The 2012 edition of the Nordic Nutrition Recommendations (NNR) included recommendations on breastfeeding, based on the most recent guidelines and recommendations from major national food and health authorities and organizations, systematic reviews, and some original research. For NNR 2023, the scope has been expanded and also includes formula feeding and the introduction of solid food. The main focus in this scoping review is on infants aged 0-12 months but also considers parts both before and beyond the first year, as the concept of 'the first 1000 days' emphasizes the importance of factors during pregnancy and the first 2 years of life for immediate and later health: physical as well as emotional and mental health. Breastmilk is the natural and sustainable way to feed an infant during the first months of life. Numerous studies have indicated immediate as well as long-term beneficial effects of breastfeeding on health for both the infant and the breastfeeding mother, and from a public health perspective, it is therefore important to protect, support, and promote breastfeeding. For full-term, normal weight infants, breastmilk is sufficient as the only form of nutrition for the first 6 months, except for vitamin D that needs to be given as supplement. The World Health Organization (WHO) and several other authoritative bodies therefore recommend exclusive breastfeeding during the first 6 months. Starting solids at about 6 months is necessary for both nutritional and developmental reasons. According to the European Food Safety Authority (EFSA) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), solid foods are safe to give from 4 months although exclusive breastfeeding until 6 months is the desirable goal. Breastfeeding can continue together with complementary foods as long as it is mutually desired by the mother and child. If breastfeeding is not enough or for some reason discontinued before the infant is 4 months of age, the infant should be fed infant formula, and, when possible, breastfeeding should be continued alongside the formula feeding. If the infant is 4 months or older, starting with solids together with continued breastfeeding and/or formula feeding is an option. Infant formulas have been developed for infants who are not breastfed or do not get enough breastmilk. Home-made formula should not be given.
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Affiliation(s)
- Agneta Hörnell
- Department of Food, Nutrition and Culinary Science, Umeå University, Umeå, Sweden
| | - Hanna Lagström
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
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18
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Liao CC, Chien CH, Hsu TJ, Li JM. Advancing breastfeeding promotion: leveraging integrative natural galactagogues and unveiling their potential roles-Insights from a 19-year Taiwan nationwide registry to address lactation insufficiency in postpartum women. Front Nutr 2024; 11:1293735. [PMID: 38371501 PMCID: PMC10869601 DOI: 10.3389/fnut.2024.1293735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/15/2024] [Indexed: 02/20/2024] Open
Abstract
Background Lactation insufficiency is a prevalent challenge for nursing mothers globally. There is a growing interest in the use of herbal galactagogues for enhancing lactation, but their therapeutic efficacy and underlying mechanisms need thorough investigation. This study aims to investigate the efficacy and mechanisms of action of herbal galactagogues in addressing lactation insufficiency by utilizing real-world data and employing a network analysis approach. Methods Our retrospective study used Taiwan's Longitudinal Health Insurance Database 2000 (LHID2000) to identify 490 patients diagnosed with lactation insufficiency from 2000 to 2018. We analyzed demographic characteristics, co-existing diseases, and prescription patterns for both users and non-users of Chinese herbal products (CHP). Additionally, we utilized a network analysis approach to explore potential compounds and targets in the most frequently used CHP, the Wang Bu Liu Xing and Lu Lu Tong herb pair (WLHP) combination. Results Out of 490 patients, 81% were CHP users. There were no significant differences in demographic characteristics between CHP users and non-users, but we observed a notable divergence in the prevalence of co-existing diseases. A detailed examination of CHP prescriptions revealed the predominance of WLHP, prompting further investigation. Comprehensive analysis identified 29 major compounds in WLHP, which were associated with 215 unique targets. Intersection analysis revealed 101 overlapping targets between WLHP and lactation, suggesting their potential as therapeutic targets for lactation insufficiency treatment. Topological analysis of the protein-protein interaction (PPI) network identified 13 hub genes potentially crucial for the therapeutic effect of WLHP. Functional enrichment analysis showed that these targets were involved in critical lactation regulation pathways, including the PI3K-Akt signaling pathway, prolactin signaling pathway, estrogen signaling pathway, and AMPK signaling pathway. Discussion This study emphasizes the potential of CHP, specifically the WLHP combination, in managing lactation insufficiency. The multi-compound, multi-target approach of WLHP and its interaction with key biological processes and signaling pathways offer valuable insights into the underlying mechanisms of its therapeutic effects. These findings warrant further experimental validation and can guide future research and clinical applications of CHP in lactation insufficiency treatment.
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Affiliation(s)
- Chung-Chih Liao
- Department of Post-Baccalaureate Veterinary Medicine, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Chuyuan Chinese Medicine Clinic, Taichung, Taiwan
| | - Chi-Hsien Chien
- Department of Post-Baccalaureate Veterinary Medicine, Asia University, Taichung, Taiwan
| | - Tzu-Ju Hsu
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Jung-Miao Li
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
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19
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Cosemans C, Bongaerts E, Vanbrabant K, Reimann B, Silva AI, Tommelein E, Poma G, Ameloot M, Nawrot TS, Plusquin M. Black carbon particles in human breast milk: assessing infant's exposure. Front Public Health 2024; 11:1333969. [PMID: 38298262 PMCID: PMC10828029 DOI: 10.3389/fpubh.2023.1333969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024] Open
Abstract
Background/Aim Human breast milk is the recommended source of nutrition for infants due to its complex composition and numerous benefits, including a decline in infection rates in childhood and a lower risk of obesity. Hence, it is crucial that environmental pollutants in human breast milk are minimized. Exposure to black carbon (BC) particles has adverse effects on health; therefore, this pilot study investigates the presence of these particles in human breast milk. Methods BC particles from ambient exposure were measured in eight human breast milk samples using a white light generation under femtosecond illumination. The carbonaceous nature of the particles was confirmed with BC fingerprinting. Ambient air pollution exposures (PM2.5, PM10, and NO2) were estimated using a spatial interpolation model based on the maternal residential address. Spearman rank correlation coefficients were obtained to assess the association between human breast milk's BC load and ambient air pollution exposure. Results BC particles were found in all human breast milk samples. BC loads in human breast milk were strongly and positively correlated with recent (i.e., 1 week) maternal residential NO2 (r = 0.79; p = 0.02) exposure and medium-term (i.e., 1 month) PM2.5 (r = 0.83; p = 0.02) and PM10 (r = 0.93; p = 0.002) exposure. Conclusion For the first time, we showed the presence of BC particles in human breast milk and found a robust association with ambient air pollution concentrations. Our findings present a pioneering insight into a novel pathway through which combustion-derived air pollution particles can permeate the delicate system of infants.
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Affiliation(s)
- Charlotte Cosemans
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Eva Bongaerts
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Kenneth Vanbrabant
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Brigitte Reimann
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Ana Inês Silva
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Eline Tommelein
- Department of Pharmaceutical and Pharmacological Sciences, Experimental Pharmacology, Vrije Universiteit Brussel, Jette, Belgium
| | - Giulia Poma
- Toxicological Centre, University of Antwerp, Wilrijk, Belgium
| | - Marcel Ameloot
- Biomedical Research Institute (BIOMED), Hasselt University, Diepenbeek, Belgium
| | - Tim S. Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
- School of Public Health, Occupational and Environmental Medicine, Leuven University, Leuven, Belgium
| | - Michelle Plusquin
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
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20
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Reddy N S, Dharmaraj A, Jacob J, Sindhu KN. Exclusive breastfeeding practices and its determinants in Indian infants: findings from the National Family Health Surveys-4 and 5. Int Breastfeed J 2023; 18:69. [PMID: 38124065 PMCID: PMC10731841 DOI: 10.1186/s13006-023-00602-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) in infants for the first 6 months of life. This analysis aims to estimate the proportion of Indian infants exclusively breastfed for the first 6 months using the National Family Health Surveys (NFHS)-4 and 5, and further, determine factors associated with EBF practices. METHODS EBF for this analysis was defined as when infants received only breast milk and no complementary feeds (solid food, water, animal milk, baby formula, juice, and fortified food) in the last 24 h prior to the survey. The proportion of infants exclusively breastfed was plotted from birth to 6 months as per the age of children at the time of the survey, and this was computed for individual states, union territories, and overall, for India. Univariate and multivariable logistic regression analyses were performed to examine factors influencing EBF in Indian infants. RESULTS The proportion of Indian infants exclusively breastfed for 6 months was 31.3% (1280/4095; 95% CI 29.9, 32.7) and 43% (1657/3853; 95% CI 41.4, 44.6) as per the NFHS-4 and 5 surveys, respectively. In NFHS-5, infants of scheduled tribes (aOR 1.5; 95% CI 1.2, 1.9) and mothers who delivered at public health facilities (aOR 1.3; 95% CI 1.1, 1.5) showed an increased odds of being exclusively breastfed at 6 months of life compared to their counterparts. Further, infants of mothers aged < 20 years (aOR 0.5; 95% CI 0.4, 0.7), low birth weight infants (aOR 0.6; 95% CI 0.4, 0.8), and infants in whom breastfeeding was initiated one hour after birth (aOR 0.8; 95% CI 0.7, 0.9) showed a reduced odds of being exclusively breastfed at 6 months compared to their counterparts. CONCLUSIONS The overall EBF practice showed an increasing trend in the NFHS-5 compared to the NFHS-4 survey. However, a vast gap remains unaddressed in the Indian setting with > 50% of the population still not exclusively breastfeeding their infants for the WHO recommended duration of first 6 months. Behavioral studies dissecting the complex interplay of factors influencing EBF within the heterogenous Indian population can help plan interventions to promote and scale-up EBF in Indian infants.
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Affiliation(s)
- Samarasimha Reddy N
- Division of Clinical Epidemiology, ICMR - National Institute of Nutrition, Hyderabad, Telangana, 500007, India
| | - Aravind Dharmaraj
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Jovis Jacob
- Division of Clinical Epidemiology, ICMR - National Institute of Nutrition, Hyderabad, Telangana, 500007, India
| | - Kulandaipalayam Natarajan Sindhu
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India.
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21
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Monge-Montero C, van der Merwe LF, Tagliamonte S, Agostoni C, Vitaglione P. Why do mothers mix milk feed their infants? Results from a systematic review. Nutr Rev 2023:nuad134. [PMID: 38041551 DOI: 10.1093/nutrit/nuad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
CONTEXT Combining or supplementing breastfeeding with formula feeding, also called mixed milk feeding (MMF), is a common infant feeding practice. However, there is no well-established MMF evidence-base for informing and guiding parents. A better understanding of the reasons why mothers practice MMF may facilitate identification of efficient strategies for supporting exclusive breastfeeding, and/or opportunities to prolong breastfeeding, at least partially. OBJECTIVE An updated systematic literature review was undertaken with the primary aim of gaining a deeper understanding of the reasons why mothers choose MMF. DATA SOURCES Six databases were searched for relevant articles published in English from January 2012 to January 2022. DATA EXTRACTION Two reviewers independently performed the screenings and data extraction, and any differences were resolved by a third reviewer. Data from 138 articles were included, 90 of which contained data on MMF reasons/drivers, and 60 contained data on infant age and/or maternal demographic factors associated with MMF. DATA ANALYSIS A total of 13 different unique MMF drivers/reasons were identified and categorized according to whether the drivers/reasons related to perceived choice, necessity, or pressure. Risk of bias was evaluated using the Quality Assessment Tool of Diverse Studies and the JBI Systematic Reviews tool. Several different terms were used to describe and classify MMF across the studies. The most commonly reported reasons for MMF were related to a perception of necessity (39% of drivers, eg, concerns about infant's hunger/perceived breast milk insufficiency or breastfeeding difficulties), followed by drivers associated with perceived choice (34%; eg, having more flexibility) and perceived pressure (25%; eg, returning to work or healthcare professionals' advice). This was particularly true for infants aged 3 months or younger. CONCLUSION The key global drivers for MMF and their distribution across infant age and regions were identified and described, providing opportunities for the provision of optimal breastfeeding support. A unified definition of MMF is needed in order to enable more comparable and standardized research. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022304253.
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Affiliation(s)
- Carmen Monge-Montero
- Department of Research, Monge Consultancy Food and Nutrition Research, Leiden, The Netherlands
| | | | - Silvia Tagliamonte
- Department of Agricultural Sciences, University of Naples Federico II, Naples, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ospedale Maggiore Policlinico, Pediatric Clinic, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Vitaglione
- Department of Agricultural Sciences, University of Naples Federico II, Naples, Italy
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22
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Basbous M, Yehya N, Salti N, Tamim H, Nabulsi M. Cost-benefit analysis of a multicomponent breastfeeding promotion and support intervention in a developing country. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.17.23298704. [PMID: 38014286 PMCID: PMC10680883 DOI: 10.1101/2023.11.17.23298704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Studies evaluating breastfeeding promotion and support interventions suggest some economic benefits. This study assessed the direct and indirect costs of a multicomponent breastfeeding promotion and support intervention during the first two years of the infant's life. Methods This is a cost-benefit analysis of data generated from a randomized controlled trial that aimed at investigating whether provision of a multicomponent breastfeeding promotion and support intervention to Lebanese mothers in the first six months postpartum would improve breastfeeding rates compared to standard obstetric and pediatric care. Data on 339 participants included information on maternal socio-demographics and health, infant nutrition and health, and direct and indirect costs of the intervention. The primary outcome was the benefit-cost ratio (BCR) of the intervention at one, six, 12, and 24 months. Secondary outcomes included the overall costs of infant nutrition and infant-mother dyad health costs during the first two years. Multiple linear regression models investigated the effect of the multicomponent intervention (independent variable) on the overall infant nutrition cost and the overall mother-infant health costs (as dependent variables), adjusting for monthly income and number of children (confounders) at different time points in the first two years. Similar regression models investigated the association between infant nutrition type (exclusive breastfeeding, mixed feeding, artificial milk) and infant nutrition costs and infant-mother health costs. Intention to treat analyses were conducted using SPSS (version 24). Statistical significance was set at a p -value below 0.05. Results The prevalence of Exclusive/Predominant breastfeeding among participants declined from 51.6% in the first month to 6.6% at the end of second year. The multicomponent breastfeeding intervention incurred 485 USD more in costs than the control group during the first six months but was cost-efficient by the end of the first year (incremental net benefits of 374 USD; BCR=2.44), and by the end of the second year (incremental net benefits of 472 USD; BCR=2.82). In adjusted analyses, the intervention was significantly associated with fewer infant illness visits in the first year ( p =0.045). Stratified analyses by the type of infant nutrition revealed that infants who were on Exclusive/Predominant , or Any Breastfeeding had significantly more favorable health outcomes at different time points during the first two years ( p <0.05) compared to infants receiving Artificial Milk only, with health benefits being highest in the Exclusive/Predominant breastfeeding group. Moreover, Exclusive/Predominant and Any Breastfeeding had significantly lower costs of infant illness visits, hospitalizations, and infant medications during the two years ( p <0.05), but had additional cost for maternal non-routine doctor visits due to breastfeeding (all p values <0.05). Whereas the overall cost (direct and indirect) during the first six months was significantly lower for the Exclusive/Predominant breastfeeding infants ( p =0.001), they were similar in infants on Mixed Feeding or Artificial Milk . Conclusions Breastfeeding is associated with significant economic and infant health benefits in the first two years. In the context of the current economic crisis in Lebanon, this study provides further evidence to policymakers on the need to invest in national breastfeeding promotion and support interventions.
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23
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Xu WH, Chen YR, Tian HM, Chen YF, Gong JY, Yu HT, Liu GL, Xie L. Effects of dietary PUFA patterns and FADS genotype on breast milk PUFAs in Chinese lactating mothers. GENES & NUTRITION 2023; 18:16. [PMID: 37880594 PMCID: PMC10598896 DOI: 10.1186/s12263-023-00735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Breastfeeding affects the growth and development of infants, and polyunsaturated fatty acids (PUFAs) play a crucial role in this process. To explore the factors influencing the PUFA concentration in breast milk, we conducted research on two aspects: dietary fatty acid patterns and single nucleotide polymorphisms (SNPs) in maternal fatty acid desaturase genes. METHODS Three hundred seventy Chinese Han lactating mothers were recruited. A dietary semi-quantitative food frequency questionnaire (FFQ) was used to investigate the dietary intake of lactating mothers from 22 to 25 days postpartum for 1 year. Meanwhile, breast milk samples were collected from the participants and tested for the concentrations of 8 PUFAs and 10 SNP genotypes. We sought to determine the effect of dietary PUFA patterns and SNPs on breast milk PUFAs. We used SPSS 24.0 statistical software for data analysis. Statistical tests were all bilateral tests, with P < 0.05 as statistically significant. RESULTS Under the same dietary background, PUFA contents in breast milk expressed by most major allele homozygote mothers tended to be higher than that expressed by their counterparts who carried minor allele genes. Moreover, under the same gene background, PUFA contents in breast milk expressed by the mother's intake of essential PUFA pattern tended to be higher than that expressed by their counterparts who took the other two kinds of dietary. CONCLUSIONS Our study suggests that different genotypes and dietary PUFA patterns affect PUFA levels in breast milk. We recommend that lactating mothers consume enough essential fatty acids to ensure that their infants ingest sufficient PUFAs.
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Affiliation(s)
- Wen-Hui Xu
- Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, No. 1163 Xinmin Street, Changchun, 130021, Jilin Province, China
| | - Yi-Ru Chen
- Department of Clinical Nutrition, China-Japan, Union Hospital of Jilin University, Changchun, 130032, Jilin Province, China
| | - Hui-Min Tian
- School of Nursing, Jilin University, Changchun, 130021, Jilin Province, China
| | - Yi-Fei Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, No. 1163 Xinmin Street, Changchun, 130021, Jilin Province, China
| | - Jia-Yu Gong
- Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, No. 1163 Xinmin Street, Changchun, 130021, Jilin Province, China
| | - Hai-Tao Yu
- Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, No. 1163 Xinmin Street, Changchun, 130021, Jilin Province, China
| | - Guo-Liang Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, No. 1163 Xinmin Street, Changchun, 130021, Jilin Province, China
| | - Lin Xie
- Department of Nutrition and Food Hygiene, School of Public Health, Jilin University, No. 1163 Xinmin Street, Changchun, 130021, Jilin Province, China.
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Zunza M, Young T, Cotton M, Slogrove A, Mbuagbaw L, Kuhn L, Thabane L. Evaluating interactive weekly mobile phone text messaging plus motivational interviewing for breastfeeding promotion among women living with HIV, giving normal birth at a primary healthcare facility in South Africa: a feasibility randomised controlled trial. BMJ Open 2023; 13:e073385. [PMID: 37816561 PMCID: PMC10565338 DOI: 10.1136/bmjopen-2023-073385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/22/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES We assessed the feasibility of an appropriately powered randomised trial by evaluating whether participants could be recruited and retained, and sought preliminary information on exclusive breastfeeding rates. SETTING Primary healthcare facility, serving a rural community. PARTICIPANTS Women initiating breast feeding within 24 hours of giving birth, on antiretroviral treatment and aged ≥18 years. INTERVENTIONS We randomised mother-infant pairs to receive weekly text messaging encouraging exclusive breast feeding plus in-person individual motivational interviews post partum at weeks 2, 6 and 10, or standard infant feeding counselling. OUTCOME MEASURES The feasibility endpoints included number of participants who consented to participate and number with complete evaluation of infant feeding practices at study visits. Exploratory endpoints included number of participants who exclusively breast fed at 24 weeks post partum and number of participants adhering to study protocol. RESULTS Of 123 mothers screened, 52 participants consented for participation. We recruited an average of five participants per month over 11 months. Most participants were unemployed (75%), had some high school education (84%) and had disclosed their HIV status to someone close (88%). About 65% participants completed outcome evaluation at week 10, decreasing to 35% at week 24. Twenty participants had the week 24 visit planned between 20 March and August 2020, during COVID-19 lockdown. Of these, 4 completed the visit telephonically, 16 were lost to follow-up. Exclusive breastfeeding rate remained relatively high across both groups through week 24. The difference in exclusive breastfeeding rates between the intervention and control groups was minimal: rate difference 22.2% (95% CI -20.1% to 64.5%). CONCLUSIONS With a large eligible target population, recruitment targets could be achieved for a large trial. Strategies to retain participants, such as remote monitoring and in-person follow-up visits, will be essential. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT02949713) and Pan African Clinical Trial Registry (PACTR201611001855404).
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Affiliation(s)
- Moleen Zunza
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Taryn Young
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Mark Cotton
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Amy Slogrove
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Lawrence Mbuagbaw
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Louise Kuhn
- Gertude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Lehana Thabane
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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25
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Peña‐Ruiz LS, Unar‐Munguía M, Colchero MA, Alarid‐Escudero F, Pérez‐Escamilla R. Breastfeeding is associated with the intelligence of school-age children in Mexico. MATERNAL & CHILD NUTRITION 2023; 19:e13534. [PMID: 37218453 PMCID: PMC10483941 DOI: 10.1111/mcn.13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
Breastfeeding has been consistently associated with higher intelligence since childhood. However, this relation could be confounded due to maternal selection bias. We estimated the association between predominant breastfeeding and intelligence in school-age children considering potential selection bias and we simulated the intelligence gap reduction between low versus higher socioeconomic status children by increasing breastfeeding. We analysed predominant breastfeeding practices (breastmilk and water-based liquids) of children 0-3 years included in the Mexican Family Life Survey (MxFLS-1). Intelligence was estimated as the z-score of the abbreviated Raven score, measured at 6-12 years in the MxFLS-2 or MxFLS-3. We predicted breastfeeding duration among children with censored data with a Poisson model. We used the Heckman selection model to assess the association between breastfeeding and intelligence, correcting for selection bias and stratified by socioeconomic status. Results show after controlling for selection bias, a 1-month increase in predominant breastfeeding duration was associated with a 0.02 SD increase in the Raven z-score (p < 0.05). The children who were predominantly breastfed for 4-6 months versus <1 month had 0.16 SD higher Raven z-score (p < 0.05). No associations were found using multiple linear regression models. Among low socioeconomic status children, increasing predominantly breastfeeding duration to 6 months would increase their mean Raven z-score from -0.14 to -0.07 SD and reduce by 12.5% the intelligence gap with high socioeconomic status children. In conclusion, predominant breastfeeding duration was significantly associated with childhood intelligence after controlling for maternal selection bias. Increased breastfeeding duration may reduce poverty-driven intelligence inequities.
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Affiliation(s)
- Lidia Sarahi Peña‐Ruiz
- Department of Maternal, Child and Adolescent Nutrition, Center for Research on Health and NutritionNational Institute of Public HealthCuernavacaMorelosMexico
| | - Mishel Unar‐Munguía
- Department of Maternal, Child and Adolescent Nutrition, Center for Research on Health and NutritionNational Institute of Public HealthCuernavacaMorelosMexico
| | - Mónica Arantxa Colchero
- Department of Health Economics, Center for Research on Health SystemsNational Institute of Public HealthCuernavacaMorelosMexico
| | - Fernando Alarid‐Escudero
- Department of Health Policy, School of MedicineStanford UniversityCAUS
- Center for Health PolicyFreeman Spogli Institute, Stanford UniversityCAUS
| | - Rafael Pérez‐Escamilla
- Department of Social and Behavioral ScienceYale School of Public Health, Yale UniversityNew HavenConnecticutUSA
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26
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Flaathen EME, Johannessen HH, Bakke J, Holm C, Mørkved S, Salvesen KÅ, Stafne SN. Does regular antenatal exercise promote exclusive breastfeeding during the first 3 months of life? Secondary analyses of a randomized controlled trial. Eur J Midwifery 2023; 7:20. [PMID: 37636831 PMCID: PMC10450771 DOI: 10.18332/ejm/167807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/05/2023] [Accepted: 06/27/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Exclusive breastfeeding (EBF) and antenatal exercise are independently associated with positive short- and long-term health effects for women and their children. The aims of the study were to investigate whether antenatal exercise promotes EBF three months postpartum and further to explore factors associated with EBF at three months postpartum. METHODS This study was a follow-up of a Norwegian two-center randomized controlled trial to assess the effect of an antenatal exercise protocol. The recruited pregnant women were randomized to either a 12-week standardized antenatal exercise program with one weekly group training led by a physiotherapist and two weekly home training sessions or standard antenatal care. Women reported breastfeeding status in a questionnaire at three months postpartum. RESULTS Of the 726 women, 88% were EBF at three months postpartum. There was no significant difference in EBF rates between the intervention group (87%) and the control group (89%). EBF was positively associated with maternal education (AOR=3.4; 95% CI: 1.7-6.7) and EBF at discharge from the hospital (AOR=22.2; 95% CI: 10-49). Admission to neonatal intensive care unit was identified as a significant barrier to EBF (AOR=0.2; 95% CI: 0.1-0.4). Significantly more women in the non-EBF group had sought professional help compared to women in the EBF group (p≤0.001). CONCLUSIONS Regular physical exercise during pregnancy did not influence the exclusive breastfeeding rates at three months postpartum. Considering the health effects of exclusive breastfeeding and antenatal physical exercise, studies with follow-up periods beyond three months postpartum are warranted.
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Affiliation(s)
- Eva Marie E. Flaathen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Hege H. Johannessen
- Faculty of Health, Welfare and Organisation, Østfold University College, Halden, Norway
- Department of Physical Medicine and Rehabilitation, Østfold Hospital Trust, Grålum, Norway
| | - Julie Bakke
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Cecilie Holm
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Siv Mørkved
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kjell Å. Salvesen
- Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Signe N. Stafne
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Valappil HC, Jayalakshmi R, Sewor C. Intersectional inequalities in exclusive breastfeeding practices in India: analysis of national family health survey-4. Int Breastfeed J 2023; 18:44. [PMID: 37612598 PMCID: PMC10464041 DOI: 10.1186/s13006-023-00577-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/22/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Exclusive breastfeeding in the initial six months of infancy plays a significant role in the physical and cognitive development of the child. One in two children below six months of age in India is not receiving exclusive breastfeeding, with the rates varying considerably between and within states. In this study, we investigated the effect of intersecting inequalities in exclusive breastfeeding practice amongst children below six months in India. METHODS Data from the fourth National Family Health Survey (NFHS-4) was used for the study. The study used a weighed sample of 211,145 infants below six months. Exclusive breastfeeding practice was assessed based on the previous 24-hours feeding practice of the child. Intersecting social categories were created based on place of residence, religion, wealth index, and mothers' education. A binary logistic regression model was used to explore inequalities in the practice of exclusive breastfeeding based on the intersecting social categories. RESULTS Exclusive breastfeeding practices varied significantly between the intersecting categories of religion, place of residence, wealth index, and education of the mother. Exclusive breastfeeding practice prevalence was the highest amongst children born in the Urban-Secondary-Poor-Others group (57.9%) and lowest amongst the Rural-Primary-Rich-Others category (34.5). In comparison to children in the most disadvantaged category (Rural-Primary-Poor-Others), children born in the Rural-Secondary-Poor-Others category had the highest odds [OR (odds ratio) 1.213; 95% CI 1.024, 1.437] of being exclusively breastfed, whilst children within the Rural-Primary-Rich-Others category had the lowest odds (OR 0.494; 95% CI 0.345, 0.708). Wide disparities were observed in the odds of engaging in exclusive breastfeeding practice amongst the middle groups than between the most advantaged and the most disadvantaged groups. The inequality indices show varied distribution of exclusive breastfeeding prevalence across the intersecting groups with higher exclusive breastfeeding prevalence noted amongst disadvantaged groups. CONCLUSIONS The study found that intersecting inequalities in exclusive breastfeeding exist in India. In order to improve exclusive breastfeeding practice, targeted interventions must acknowledge and adopt a comprehensive approach that addresses inherent inequalities resulting from the intersection of various axes of social stratification.
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Affiliation(s)
- Haseena Chekrain Valappil
- Department of Public Health and Community Medicine, Central University of Kerala, Tejaswini Hills, Periye, 671320, Kasaragod, Kerala, India
| | - Rajeev Jayalakshmi
- Department of Public Health and Community Medicine, Central University of Kerala, Tejaswini Hills, Periye, 671320, Kasaragod, Kerala, India.
| | - Christian Sewor
- Department of Public Health and Community Medicine, Central University of Kerala, Tejaswini Hills, Periye, 671320, Kasaragod, Kerala, India
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
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28
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Ha EK, Lee SW, Kim JH, Lee E, Cha HR, Han BE, Shin J, Han MY. Associations between Delayed Introduction of Complementary Foods and Childhood Health Consequences in Exclusively Breastfed Children. Nutrients 2023; 15:3410. [PMID: 37571347 PMCID: PMC10421357 DOI: 10.3390/nu15153410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
The timing of complementary food (CF) introduction is closely related to childhood health, and it may vary depending on the region, culture, feeding type, or health condition. Despite numerous studies on the benefits of breastfeeding and the optimal timing of CF introduction, there have been limited investigations regarding delayed CF introduction in exclusively breastfed children. We compared an exposed group (CF introduction ≥7 months) with a reference group (CF introduction at 4 -< 7 months) regarding hospital admission, disease burden, and growth until age 10. Data from a nationwide population-based cohort study involving children born between 2008 and 2012 in the South Korea were analyzed. The final cohort comprised 206,248 children (165,925 in the exposed group and 40,323 in the reference group). Inverse probability of treatment weighting with propensity score matching was used to balance baseline health characteristics in the comparison groups. We estimated the incident risk ratios (IRR) for outcomes using modified Poisson regression and weighted odds ratios (weighted ORs) and their 95% confidence intervals (CIs) using multinomial logistic regression. The exposed group was associated with low height-for-age z-score (HAZ) (IRR (95% CI) for -1.64 < HAZ ≤ -1.03: 1.11 (1.08 to 1.14); HAZ ≤ -1.64: 1.21 (1.14 to 1.27)) and frequent (≥6 events) hospitalizations (weighted OR 1.18 (1.09 to 1.29). The rates of hospital admission, death, and specific medical conditions did not differ between groups. However, delaying the introduction of CF until seven months in exclusively breastfed infants was associated with frequent hospitalization events and lower heights.
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Affiliation(s)
- Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Seung Won Lee
- School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea; (S.W.L.); (H.R.C.)
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea;
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Republic of Korea;
| | - Hye Ryeong Cha
- School of Medicine, Sungkyunkwan University, Suwon 16419, Republic of Korea; (S.W.L.); (H.R.C.)
| | - Bo Eun Han
- Department of Software, Sejong University, Seoul 05006, Republic of Korea;
| | - Jeewon Shin
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea;
| | - Man Yong Han
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea;
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29
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Chiang KV, Hamner HC, Li R, Perrine CG. Timing of Introduction of Complementary Foods - United States, 2016-2018. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 69:1969-1973. [PMID: 37498788 DOI: 10.15585/mmwr.mm6953a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
The American Academy of Pediatrics (AAP) recommends introducing complementary foods (i.e., any solid or liquid other than breast milk or infant formula) to infants at approximately age 6 months (1). Although a consensus on ideal timing is lacking, most experts agree that introduction of complementary foods before age 4 months is too early because of infant gastrointestinal and motor immaturity (1,2). In addition, early introduction prevents exclusively breastfed infants from reaching the recommended 6 months of exclusive breastfeeding (1) and might be associated with increased risk for overweight and obesity (3). Nationally representative data on complementary feeding are limited; state-level estimates have been previously unavailable. CDC analyzed 2016-2018 data from the National Survey of Children's Health (NSCH) (N = 23,743) to describe timing of complementary feeding introduction and prevalence of early introduction of complementary foods before age 4 months (early introduction) among children aged 1-5 years. Prevalence of early introduction was 15.6% nationally and varied geographically and across sociodemographic and infant feeding characteristics. These estimates suggest that approximately one in six infants are introduced to complementary foods before they are developmentally ready. Efforts by health care providers and others who might influence infant feeding practices could help decrease the number of infants who are introduced to complementary foods too early.
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Mohammed S, Webb EL, Calvert C, Glynn JR, Sunny BS, Crampin AC, McLean E, Munthali-Mkandawire S, Lazarous Nkhata Dube A, Kalobekamo F, Marston M, Oakley LL. Effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13-year follow-up study in Malawi. Sci Rep 2023; 13:11413. [PMID: 37452129 PMCID: PMC10349128 DOI: 10.1038/s41598-023-38455-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023] Open
Abstract
The benefits of exclusive breastfeeding (EBF) for infant health and survival are well documented. However, its impact on educational outcomes has been contested and poorly researched in Africa. It has been hypothesised that positive associations reported in high-income countries can be attributed to residual confounding by socioeconomic status (SES). Our study investigated whether EBF duration in infancy is associated with educational attainment and age-for-grade attainment trajectories at school-age in rural Malawi. Longitudinal data on 1021 children at the Karonga demographic surveillance site in Malawi were analysed. Breastfeeding data were collected 3 months after birth and again at age one. The school grade of each child was recorded each year from age 6 until age 13. We calculated age-for-grade based on whether a child was at, over, or under the official expected age for a grade. Generalised estimating equations estimated the average effect of breastfeeding on age-for-grade. Latent class growth analysis identified age-for-grade trajectories, and multinomial logistic regression examined their associations with EBF. Maternal-child characteristics, SES, and HIV status were controlled. Overall, 35.9% of the children were exclusively breastfed for 6 months. Over-age for grade steadily increased from 9.6% at age 8 to 41.9% at age 13. There was some evidence that EBF for 6 months was associated with lower odds of being over-age for grade than EBF for less than 3 months (aOR = 0.82, 95%CI = 0.64-1.06). In subgroup analyses, children exclusively breastfed for 6 months in infancy were less likely to be over-age for grades between ages 6-9 (aOR = 0.64, 95%CI = 0.43-0.94). Latent class growth analysis also provided some evidence that EBF reduced the odds of falling behind in the early school grades (aOR = 0.66, 95%CI = 0.41-1.08) but not later. Our study adds to the growing evidence that EBF for 6 months has benefits beyond infant health and survival, supporting the WHO's recommendation on EBF.
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Affiliation(s)
- Shamsudeen Mohammed
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Emily L Webb
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Judith R Glynn
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Bindu S Sunny
- United Nations Educational, Scientific and Cultural Organization, Paris, France
| | - Amelia C Crampin
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Estelle McLean
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | | | | | - Milly Marston
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Laura L Oakley
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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B M, Patani J, Ekambaram G, P P. Effect of Allium sativum consumption for breast feeding among postnatal Indian mothers. Bioinformation 2023; 19:698-702. [PMID: 37885786 PMCID: PMC10598363 DOI: 10.6026/97320630019698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 10/28/2023] Open
Abstract
Breast milk is a unique form of nutrition for babies since it provides all of the essential nutrients for growth and development. Breastfeeding may also play a role in decreasing postpartum depression, and reduced the risk of breast and ovarian cancer in future. Garlic has been used as a galactogogue in India since many years. The study's major goal was to determine the effect of garlic consumption in promotion of breast feeding among the postnatal mothers in Nootan General Hospital Visnagar, India. The study employed a pre-experimental one-group pre and post-test research design, with the sample drawn via non-probability convenience sampling. The baseline preform and the 12-point modified adequacy of breast feeding checklist were used to collect data. The mean pre-test score was 3.33, and the mean post-test score was 8.33 in this study's data analysis. 5.47 was the average difference. The post-test mean was lower than the pre-test mean, indicating that garlic preparation consumption promotes breastfeeding among postnatal mothers. The pre-test stress score had a standard deviation of 2.56, while the post-test stress score had a standard deviation of 2.57.
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Affiliation(s)
- Mahalakshmi B
- />Department of Pediatric nursing, Nootan College of Nursing, Sankalchand Patel University, Visnagar-384315, Gujarat, India
| | - Jignasaben Patani
- />Department of Community Medicine, Nootan Medical College and Research Centre, Sankalchand Patel University, Visnagar-384315, Gujarat, India
| | - Gnanadesigan Ekambaram
- />Department of Physiology, Nootan Medical College and Research Centre, Sankalchand Patel University, Visnagar-384315, Gujarat, India
| | - Padmavathi P
- />Department of Biochemistry, ACS Medical College and Hospital, DR MGR Education and Research institute University, Chennai-600077,Tamil Nadu, India
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Getachew D, Haftu D, Yosef T. Determinants of early interruption of exclusive breastfeeding at Dollo Ado refugee camps, Dollo Ado district, Ethiopia. Pan Afr Med J 2023; 45:105. [PMID: 37719053 PMCID: PMC10504441 DOI: 10.11604/pamj.2023.45.105.35949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 03/03/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction nearly three-quarters of infants younger than six months were not exclusively breastfed globally. Despite some research indicating what factors influence early exclusive breastfeeding interruption in Ethiopia's stable population, there is little evidence indicating what factors influence exclusive breastfeeding interruption in vulnerable populations such as refugee camps. Therefore, this study aimed to determine the factors that contributed to the early termination of exclusive breastfeeding in Ethiopian refugee camps in the Dollo Ado district. Methods a case-control study was conducted at the Dollo Ado refugee camps from April 05th to 25th, 2017. The eligible 112 cases and 224 controls were identified using the 24-hour recall method. The information was gathered using an interviewer-administered questionnaire that was pretested and organized. Logistic regression analysis was computed to assess the effect of independent variables. Results the determinants for early interruption of exclusive breastfeeding were not counseled about infant feeding during antenatal care follow-up (adjusted odds ratio (AOR =5.87, 95% CI [2.61-13.1]), not counseled about infant feeding during postnatal care service use (AOR= 4.33, 95% CI [2.71-10.8), breastfeeding problem (AOR= 5.62, 95% CI [4.55-15.2]) and late initiation of breastfeeding (AOR= 4.79, 95% CI [28-10.1]). Conclusion in this study, early termination of exclusive breastfeeding was caused by breastfeeding problems and late commencement of breastfeeding, as well as not receiving infant feeding advice during antenatal care or postnatal care. The results of this study highlight the significance of concentrating on newborn and young child feeding counseling during prenatal and postnatal care services in order to promote exclusive breastfeeding. In addition, health providers should educate parents on the significance of starting exclusive breastfeeding on time and obtaining help right away if there is a problem, such as breast soreness or the infant refusing to eat due to oral trash, to avoid early exclusive breastfeeding interruption.
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Affiliation(s)
- Dawit Getachew
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Desta Haftu
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tewodros Yosef
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia
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Pawar A, Zabetakis I, Gavankar T, Lordan R. Milk polar lipids: Untapped potential for pharmaceuticals and nutraceuticals. PHARMANUTRITION 2023. [DOI: 10.1016/j.phanu.2023.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Rios-Leyvraz M, Yao Q. Calcium, zinc, and vitamin D in breast milk: a systematic review and meta-analysis. Int Breastfeed J 2023; 18:27. [PMID: 37264448 PMCID: PMC10233556 DOI: 10.1186/s13006-023-00564-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/20/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Global estimates of calcium, zinc and vitamin D content in breastmilk are lacking. The objective of this systematic review was to determine the calcium, zinc, and vitamin D content in breast milk. METHODS A systematic search of the online databases Embase, MEDLINE, and CENTRAL was conducted in November 2022 and complemented by searches of the African Journals Online database and the LILACS database, and reference lists. Studies reporting the calcium, zinc and vitamin D content in breast milk of apparently healthy mothers and infants were included. Random effects meta-analyses were conducted. The effect of influencing factors were investigated with sub-group analyses and meta-regressions. RESULTS A total of 154 studies reporting on breast milk calcium were identified, with a mean calcium concentration in breast milk of 261 mg/L (95% CI: 238, 284). Calcium concentration was influenced by maternal health and decreased linearly over the duration of lactation. Calcium concentration at a specific time during lactation could be estimated with the equation: calcium concentration [mg/L] = 282 - 0.2331 ✕ number of days since birth. A total of 242 studies reporting on breast milk zinc were identified, with a mean zinc concentration of 2.57 mg/L (95% CI: 2.50, 2.65). Zinc concentration was influenced by several factors, such as maternal age, gestational age, and maternal diet. Zinc concentration started high in the first weeks post-partum followed by a rapid decrease over the first months. Zinc concentration at a specific time during lactation could be estimated with the equation: zinc concentration [mg/L] = 6 + 0.0005 ✕ days - 2.0266 ✕ log(days). A total of 43 studies reporting on breast milk vitamin D were identified, with a mean total antirachitic activity of breast milk of 58 IU/L (95% CI: 45, 70), which consisted mostly of 25OHD3, and smaller amounts of vitamin D3, 25OHD2 and vitamin D2. Vitamin D concentration showed wide variations between studies and was influenced by vitamin D supplementation, continent and season. CONCLUSIONS This review provides global estimates of calcium, zinc and vitamin D content in breast milk, as well as indications on changes over time and depending on influencing factors.
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Affiliation(s)
- Magali Rios-Leyvraz
- Consultant, Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Qisi Yao
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, USA
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Ericson J, Ahlsson F, Wackernagel D, Wilson E. Equally Good Neurological, Growth, and Health Outcomes up to 6 Years of Age in Moderately Preterm Infants Who Received Exclusive vs. Fortified Breast Milk-A Longitudinal Cohort Study. Nutrients 2023; 15:nu15102318. [PMID: 37242201 DOI: 10.3390/nu15102318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023] Open
Abstract
Moderately preterm infants (32-36 weeks of gestational age) have an increased risk of worse health and developmental outcomes compared to infants born at term. Optimal nutrition may alter this risk. The aim of this study was to investigate the neurological, growth, and health outcomes up to six years of age in children born moderately preterm who receive either exclusive or fortified breast milk and/or formula in the neonatal unit. In this longitudinal cohort study, data were collected for 142 children. Data were collected up to six years of age via several questionnaires containing questions about demographics, growth, child health status, health care visits, and the Five to Fifteen Questionnaire. Data on the intake of breast milk, human milk fortification, formula, and growth during hospitalization were collected from the children's medical records. No statistically significant differences in neurological outcomes, growth, or health at six years of age were found between the two groups (exclusive breast milk, n = 43 vs. fortified breast milk and/or formula, n = 99). There is a need for research in larger populations to further assess potential effects on health and developmental outcomes when comparing the use of exclusive versus fortified breast milk for moderately preterm infants during neonatal hospitalization.
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Affiliation(s)
- Jenny Ericson
- School of Education, Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
- Centre for Clinical Research Dalarna, Uppsala University, 791 82 Falun, Sweden
- Department of Pediatrics, Falu Hospital, 791 82 Falun, Sweden
| | - Fredrik Ahlsson
- Department of Women's and Children's Health, Uppsala University, 752 36 Uppsala, Sweden
| | - Dirk Wackernagel
- Division of Neonatology, Department of Pediatrics, University Medical Center of the Johannes Gutenberg, University Mainz, 55131 Mainz, Germany
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Emilija Wilson
- Department of Women's and Children's Health, Karolinska Institutet, 171 77 Stockholm, Sweden
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Thorne R, Ivers R, Dickson M, Charlton K, Pulver LJ, Catling C, Dibley M, Eckermann S, Meedya S, Buck M, Kelly P, Best E, Briggs M, Taniane J. The Marri Gudjaga project: a study protocol for a randomised control trial using Aboriginal peer support workers to promote breastfeeding of Aboriginal babies. BMC Public Health 2023; 23:823. [PMID: 37143056 PMCID: PMC10161673 DOI: 10.1186/s12889-023-15558-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/29/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Breastfeeding protects against a range of conditions in the infant, including sudden infant death syndrome (SIDS), diarrhoea, respiratory infections and middle ear infections [1, 2]. The World Health Organization (WHO) recommends exclusive breastfeeding until six months of age, with continued breastfeeding recommended for at least two years and other complementary nutritious foods [3]. The 2017-18 National Health Survey (NHS) and 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) reported that the proportion of breastfeeding in Aboriginal and Torres Strait Islander infants (0-2 years) were less than half that of non-Indigenous infants (21.2% vs. 45%, respectively)[4]. There is a lack of research on interventions supporting Aboriginal women to breastfeed, identifying an evaluation gap related to peer support interventions to encourage exclusive breastfeeding in Aboriginal women. METHODS We will evaluate the effect of scheduled breastfeeding peer support for and by Aboriginal women, on breastfeeding initiation and the prevalence of exclusive breastfeeding. This MRFF (Medical Research Future Fund) funded project is designed as a single-blinded cluster randomised controlled trial recruiting six sites across New South Wales, Australia, with three sites being randomised to employ a peer support worker or undertaking standard care. Forty pregnant women will be recruited each year from each of the six sites and will be surveyed during pregnancy, at six weeks, four and six months postnatally with a single text message at 12 months to ascertain breastfeeding rates. In-depth interviews via an Indigenous style of conversation and storytelling called 'Yarning' will be completed at pre- and post-intervention with five randomly recruited community members and five health professionals at each site" [5]. Yarns will be audio recorded, transcribed, coded and thematic analysis undertaken. Health economic analysis will be completed to assess the health system incremental cost and effects of the breastfeeding intervention relative to usual care. DISCUSSION Evidence will be given on the effectiveness of Aboriginal peer support workers to promote the initiation and continuation of breastfeeding of Aboriginal babies. The findings of this study will provide evidence of effectiveness and cost-effectiveness of including peer support workers in postnatal care to promote breastfeeding practices. TRIAL REGISTRATION ACTRN12622001208796 The impact of breastfeeding peer support on nutrition of Aboriginal infants.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Shahla Meedya
- University of Wollongong, Wollongong, Australia
- Australian Catholic University, Sydney, Australia
| | | | | | | | - Melanie Briggs
- Waminda - South Coast Women's Health & Welfare Aboriginal Corporation, Nowra, Australia
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Zhou Q, Feng XL. Breastfeeding practices in Northeast China in 2008 and 2018: cross-sectional surveys to explore determinants over a decade. Int Breastfeed J 2023; 18:25. [PMID: 37131201 PMCID: PMC10155397 DOI: 10.1186/s13006-023-00562-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/23/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND This study was conducted to investigate the prevalence and determinants of breastfeeding in 2008 and 2018, respectively, in Northeast China, where health service efficiency is at the lowest national level and regional data on breastfeeding are lacking. The influence of early initiation of breastfeeding on later feeding practices was specifically explored. METHODS Data from the China National Health Service Survey in Jilin Province in 2008 (n = 490) and 2018 (n = 491) were analysed. Multistage stratified random cluster sampling procedures were used to recruit the participants. Data collection was conducted in the selected villages and communities in Jilin. Early initiation of breastfeeding was defined as the proportion of children born in the last 24 months who were put to the breast within one hour after birth in both the 2008 and 2018 surveys. Exclusive breastfeeding was defined as the proportion of infants 0-5 months of age who were fed exclusively with breast milk in the 2008 survey; while defined as the proportion of infants 6-60 months of age who had been fed exclusively with breast milk within the first six months of life in the 2018 survey. RESULTS The prevalence of early initiation of breastfeeding (27.6% in 2008 and 26.1% in 2018) and exclusive breastfeeding during the first six months (< 50%) were low in two surveys. Logistic regression revealed that exclusively breastfeeding at six months was positively associated with early initiation of breastfeeding (OR 2.65; 95% confidence interval (CI) 1.65, 4.26) and negatively associated with caesarean section (OR 0.65; 95% CI 0.43, 0.98) in 2018. Continued breastfeeding at one year and timely introduction of complementary foods were associated with maternal residence and place of delivery, respectively, in 2018. Early initiation of breastfeeding was associated with mode and place of delivery in 2018 but residence in 2008. CONCLUSION Breastfeeding practices in Northeast China are far from optimal. The negative effect of caesarean section and positive effect of early initiation of breastfeeding on exclusive breastfeeding suggest that an institution-based approach should not be substituted by the community-based one in the formulation of breastfeeding strategies in China.
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Affiliation(s)
- Qianling Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Xing Lin Feng
- Department of Health Policy and Management, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China.
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D'Hollander CJ, McCredie VA, Uleryk EM, Keown-Stoneman CDG, Birken CS, O'Connor DL, Maguire JL. Breastfeeding support provided by lactation consultants in high-income countries for improved breastfeeding rates, self-efficacy, and infant growth: a systematic review and meta-analysis protocol. Syst Rev 2023; 12:75. [PMID: 37131212 PMCID: PMC10152596 DOI: 10.1186/s13643-023-02239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/19/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND It is well established that breast milk offers numerous health benefits for mother and child. Mothers are recommended to exclusively breastfeed their child until 6 months of age, with continued breastfeeding up to 1-2 years of age or beyond. Yet, these recommendations are met less than half of the time in high-income countries. Lactation consultants specialize in supporting mothers with breastfeeding and are a promising approach to improving breastfeeding rates. For lactation consultant interventions to be implemented widely as part of public health policy, a better understanding of their effect on breastfeeding rates and important health outcomes is needed. METHODS The overall aim of this systematic review is to evaluate the effect of lactation consultant interventions provided to women, compared to usual care, on breastfeeding rates (primary outcome), maternal breastfeeding self-efficacy, and infant growth. A search strategy has been developed to identify randomized controlled trials published in any language between 1985 and April 2023 in CENTRAL, MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science. We will also perform a search of the grey literature and reference lists of relevant studies and reviews. Two reviewers will independently extract data on study design, baseline characteristics, details of the interventions employed, and primary and secondary outcomes using a pre-piloted standardized data extraction form. Risk of bias and quality of evidence assessment will be done independently and in duplicate using the Cochrane Risk of Bias tool and GRADE approach, respectively. Where possible, meta-analysis using random-effects models will be performed, otherwise a qualitative summary will be provided. We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. DISCUSSION This review will fill an important gap in the lactation support literature. The findings will be of importance to policymakers who seek to implement interventions to improve breastfeeding rates. TRIAL REGISTRATION This review has been registered in the PROSPERO database (ID: CRD42022326597).
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Affiliation(s)
- Curtis J D'Hollander
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, St. Michael's Hospital, Toronto, ON, Canada
| | - Victoria A McCredie
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine (Respirology), Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Charles D G Keown-Stoneman
- Applied Health Research Centre, Unity Health Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Catherine S Birken
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Translational Medicine Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Jonathon L Maguire
- Department of Paediatrics, St. Michael's Hospital, Toronto, ON, Canada.
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
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Abargil M, Irani M, Klein Selle N, Atzil S. Breastfeeding at Any Cost? Adverse Effects of Breastfeeding Pain on Mother-Infant Behavior. BIOLOGY 2023; 12:biology12050636. [PMID: 37237450 DOI: 10.3390/biology12050636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023]
Abstract
Breast milk is considered the ideal infant nutrition, and medical organizations encourage breastfeeding worldwide. Moreover, breastfeeding is often perceived as a natural and spontaneous socio-biological process and one of the fundamental roles of new mothers. While breastfeeding is beneficial, little scientific consideration has been given to its potential psychological challenges. Here, we investigate the phenomenon of breastfeeding pain in mothers and its association with maternal and infant behavioral regulation. During the postpartum weeks, the mother-infant dyad can be considered one allostatic unit directed at infant regulation and development. We hypothesize that pain comprises an allostatic challenge for mothers and will thus impair the capacity for dyadic regulation. To test this, we recruited 71 mothers with varying levels of breastfeeding pain and videotaped them with their infants (2-35 weeks old) during spontaneous face-to-face interactions. We quantified the individual differences in dyadic regulation by behaviorally coding the second-by-second affective expressions for each mother and infant throughout their interactions. We tested the extent to which breastfeeding pain alters affect regulation during mother-infant interactions. We discovered that mothers with severe breastfeeding pain express less affective expressions and less infant-directed gaze during interactive moments of engagement and play than mothers with no or moderate pain. Moreover, infants of mothers experiencing pain during breastfeeding express less affective expressions and more mother-directed gaze while interacting with their mothers than infants of mothers who are not in pain. This demonstrates that the allostatic challenge of maternal pain interferes with the behavioral regulation of both mothers and infants. Since the mother-infant dyad is a codependent allostatic unit, the allostatic challenges of one partner can impact the dyad and thus potentially impact child development, bonding, and mother and infant well-being. The challenges of breastfeeding should be considered in addition to the nutritional advances.
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Affiliation(s)
- Maayan Abargil
- The Department of Psychology, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Merav Irani
- The Department of Psychology, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | | | - Shir Atzil
- The Department of Psychology, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
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de Souza J, Calsinski C, Chamberlain K, Cibrian F, Wang EJ. Investigating interactive methods in remote chestfeeding support for lactation consulting professionals in Brazil. Front Digit Health 2023; 5:1143528. [PMID: 37077406 PMCID: PMC10106757 DOI: 10.3389/fdgth.2023.1143528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
Abstract
ObjectiveLactation consultants (LCs) positively impact chestfeeding rates by providing in-person support to struggling parents. In Brazil, LCs are a scarce resource and in high demand, risking chestfeeding rates across many communities nationwide. The transition to remote consultations during the COVID-19 pandemic made LCs face several challenges to solve chestfeeding problems due to limited technical resources for management, communication, and diagnosis. This study investigates the main technological issues LCs have in remote consultations and what technology features are helpful for chestfeeding problem-solving in remote settings.MethodsThis paper implements qualitative investigation through a contextual study (n=10) and a participatory session (n=5) to determine stakeholders’ preferences for technology features in solving chestfeeding problems.FindingsThe contextual study with LCs in Brazil characterized (1) the current appropriation of technologies that help during consultations, (2) technology limitations that affect LCs’ decision-making, (3) challenges and benefits of remote consultations, and (4) cases that are easy and difficult to solve remotely. The participatory session brings LCs’ perceptions on (1) components for an effective remote evaluation, (2) preferred elements by professionals when providing remote feedback to parents, and (3) feelings about using technology resources for remote consultations.ConclusionFindings suggest that LCs adapted their methodologies for remote consultations, and the perceived benefits of this modality show interest in continuing to provide remote care as long as more integrative and nurturing applications are offered to their clients. We learned that fully remote lactation care might not be the main objective for overall populations in Brazil, but as a hybrid mode of care that benefits parents by having both modalities of consultations available to them. Finally, remote support helps reduce financial, geographic, and cultural barriers in lactation care. However, future research must identify how generalized solutions for remote lactation care can be, especially for different cultures and regions.
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Affiliation(s)
- Jessica de Souza
- Department of Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
- Correspondence: Jessica de Souza
| | | | - Kristina Chamberlain
- Division of Extended Studies, University of California San Diego, San Diego, CA, United States
| | - Franceli Cibrian
- Fowler School of Engineering, Chapman University, Orange, CA, United States
| | - Edward Jay Wang
- Department of Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
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Nambiar D, Mathew B, Dubey S, Moola S. Interventions addressing maternal and child health among the urban poor and homeless: an overview of systematic reviews. BMC Public Health 2023; 23:492. [PMID: 36918855 PMCID: PMC10015840 DOI: 10.1186/s12889-023-15410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Inequalities in access to and utilization of maternal and child health (MCH) care are hampering progress on the path to achieving the Sustainable Development Goals. In a number of Low- and Middle-Income Countries (LMICs) population subgroups at disproportionate risk of being left behind are the urban poor. Within this neglected group is the further neglected group of the homeless. Concomitantly, a number of interventions from the antenatal period onward have been piloted, tested, and scaled in these contexts. We carried out an overview of systematic reviews (SRs) to characterize the evidence around maternal and child health interventions relevant to urban poor homeless populations in LMICs. METHODS We searched Medline, Cochrane Library, Health Systems Evidence and EBSCOhost databases for SRs published between January 2009 and 2020 (with an updated search through November 2021). Our population of interest was women or children from urban poor settings in LMICs; interventions and outcomes corresponded with the World Health Organization's (WHO) guidance document. Each SR was assessed by two reviewers using established standard critical appraisal checklists. The overview was registered in PROSPERO (ID: CRD42021229107). RESULTS In a sample of 33 high quality SRs, we found no direct relevant evidence for pregnant and lactating homeless women (and children) in the reviewed literature. There was a lack of emphasis on evidence related to family planning, safe abortion care, and postpartum care of mothers. There was mixed quality evidence that the range of nutritional interventions had little, unclear or no effect on several child mortality and development outcomes. Interventions related to water, sanitation, and hygiene, ensuring acceptability of community health services and health promotion type programs could be regarded as beneficial, although location seemed to matter. Importantly, the risk of bias reporting in different reviews did not match, suggesting that greater attention to rigour in their conduct is needed. CONCLUSION The generalizability of existing systematic reviews to our population of interest was poor. There is a clear need for rigorous primary research on MCH interventions among urban poor, and particularly homeless populations in LMICs, as it is as yet unclear whether the same, augmented, or altogether different interventions would be required.
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Affiliation(s)
- Devaki Nambiar
- The George Institute for Global Health, 308 Elegance Tower, Jasola District Centre, 110025, New Delhi, India.
| | | | - Shubhankar Dubey
- Indian Council of Medical Research- Regional Medical Research Center, Bhubaneswar, Odisha, India
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Quinones C. "Breast is best"… until they say so. FRONTIERS IN SOCIOLOGY 2023; 8:1022614. [PMID: 36992698 PMCID: PMC10042138 DOI: 10.3389/fsoc.2023.1022614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/03/2023] [Indexed: 06/19/2023]
Abstract
In this autoethnographic article, I discuss the consequences of being exposed to two competing breastfeeding discourses during my first mothering experience-the "self-regulated dyad" and the "externally regulated dyad" discourse. The former represents the ideal scenario and the evidence-based practices recommended by the World Health Organization (i.e., breastfeeding on demand, internally regulated by the dyad). The externally regulated discourse refers to the standardized health interventions that take over when difficulties arise (e.g., weight gain deviations and latching issues). Building on Kugelmann's critique about our blind reliance on "standardized health," existing evidence, and my breastfeeding journey, I argue that unqualified and unindividualized breastfeeding interventions are highly counterproductive. To illustrate these points, I discuss the implications of the polarized interpretation of pain and the limited dyadically focused support. I then move on to analyze how ambivalent social positioning around breastfeeding impacts our experience. In particular, I found that I was highly regarded as a "good, responsible mum" up till my baby was 6 months, and how breastfeeding became increasingly challenged by others when my daughter was approaching her first birthday. Here, I discuss how performing attachment mothering identity work allowed me to navigate these challenges. Against this backdrop, I reflect upon feminist ambivalent positionings on breastfeeding and the complexity of balancing the promotion of women's hard-earned rights while supporting them to engage in whatever baby-feeding choice they feel appropriate. I conclude that unless we acknowledge the physical and social complexities of the process, and our healthcare systems seriously invest in allocating human resources and training them appropriately, breastfeeding rates may continue to suffer and women continue to interiorize it as their own failure.
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Affiliation(s)
- Cristina Quinones
- Department of People and Organisations, Faculty of Business and Law, The Open University, Milton Keynes, United Kingdom
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Khatib MN, Gaidhane A, Upadhyay S, Telrandhe S, Saxena D, Simkhada PP, Sawleshwarkar S, Quazi SZ. Interventions for promoting and optimizing breastfeeding practices: An overview of systematic review. Front Public Health 2023; 11:984876. [PMID: 36761137 PMCID: PMC9904444 DOI: 10.3389/fpubh.2023.984876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023] Open
Abstract
Background Optimal breastfeeding (BF) practices are essential for child survival and proper growth and development. The purpose of this overview is to evaluate the effectiveness of different interventions for promoting and optimizing breastfeeding. Methods We included systematic reviews (SRs) [including trials from Low-Income (LICs) and Low Middle-Income countries (LMICs)] that have evaluated the effect of various interventions for promoting and optimizing breastfeeding and excluded non-systematic reviews, and SRs based on observational studies. We searched various electronic databases. We followed the standard methodology as suggested by the Cochrane Handbook for Systematic Reviews of Interventions. Two sets of reviewers undertook screening followed by data extraction and assessment of the methodological quality of included SRs. Result We identified and screened 1,002 Cochrane SRs and included six SRs in this overview. Included SRs reported only two of the primary outcomes, early initiation of breastfeeding (EIBF) and/or exclusive breastfeeding (EBF). None of the included SR reported continued BF up to 2 years of age. The results were evaluated using two major comparisons groups: BF intervention against routine care and one type of BF intervention vs. other types of BF intervention. Overall results from included SRs showed that there were improvements in the rates of EIBF and EBF among women who received BF intervention such as BF education sessions and support compared to those women who received only standard care. However, BF intervention via mobile devices showed no improvements. In Target Client Communication (TCC) via mobile devices intervention group, no significant improvements were reported in BF practices, and also the reported evidence was of very low certainty. Conclusion Community Based Intervention Packages (CBIP) delivered to pregnant and reproductive-age women during their Antenatal care (ANC) and/or Postnatal care (PNC) periods by Ancillary Nurse-Midwives reported the highest improvement in EIBF compared to women who received standard care. However, insufficient evidence was reported to suggest that BF intervention showed improvements in EBF in both the comparison groups. This overview highlighted the gaps in primary research regarding the uncertainty about the settings such as LICs or LMICs, lack of evidence from LMICs, and also identified gaps in the availability of reliable up-to-date SRs on the effects of several BF interventions to promote and optimize practices. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020174998, PROSPERO [CRD42020174998].
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Affiliation(s)
- Mahalaqua Nazli Khatib
- Global Evidence Synthesis Initiative, Division of Evidence Synthesis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Abhay Gaidhane
- Centre of One Health, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Shilpa Upadhyay
- Department of Research and Development, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Shital Telrandhe
- Department of Research and Development, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Deepak Saxena
- i Health Consortium, Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Padam Prasad Simkhada
- Global Consortium of Public Health Research, School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Shailendra Sawleshwarkar
- Postgraduate Coursework Programs, Faculty of Medicine and Health, Sydney Medical School, The University of Sydney Institute for Infectious Diseases (Sydney ID), University of Sydney, Camperdown, NSW, Australia
| | - Syed Zahiruddin Quazi
- South Asia Infant Feeding Research Network (SAIFRN), Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
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Nuyttens L, De Vlieger L, Diels M, Schrijvers R, Bullens DMA. The clinical and immunological basis of early food introduction in food allergy prevention. FRONTIERS IN ALLERGY 2023; 4:1111687. [PMID: 36756279 PMCID: PMC9899849 DOI: 10.3389/falgy.2023.1111687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/04/2023] [Indexed: 01/24/2023] Open
Abstract
IgE-mediated food allergy has an estimated prevalence of 6%-10% in developed countries. Allergen avoidance has long been the main focus in the prevention of food allergy and late solid food introduction after 6-12 months of age was recommended in high-risk infants. However, the rising prevalence of food allergy despite delayed exposure to allergens and the observations that IgE-mediated sensitization to food products could even occur before the introduction of solid foods resulted in a shift towards early solid food introduction as an attempt to prevent IgE-mediated food allergy. Since then, many trials focused on the clinical outcome of early allergen introduction and overall seem to point to a protective effect on the development of IgE-mediated food allergies. For non-IgE-mediated diseases of food allergy, evidence of early food introduction seems less clear. Moreover, data on the underlying immunological processes in early food introduction is lacking. The goal of this review is to summarize the available data of immunological changes in early food introduction to prevent IgE and non-IgE mediated food allergy.
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Affiliation(s)
- L. Nuyttens
- Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium,Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - L. De Vlieger
- Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium
| | - M. Diels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - R. Schrijvers
- Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium,Department of General Internal Medicine, Division of Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium
| | - D. M. A. Bullens
- Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium,Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium,Correspondence: D. M. A Bullens
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The Effect of Educational Intervention Based on Theory of Planned Behavior Approach on Complementary Feeding: A Randomized Controlled Trial. Int J Pediatr 2023; 2023:1086919. [PMID: 36712578 PMCID: PMC9876695 DOI: 10.1155/2023/1086919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/19/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
Complementary feeding should be given to infants at 6 months in addition to breastmilk. Mothers' knowledge and behavior in giving adequate complementary feeding are crucial to prevent malnutrition risk. During the pandemic, conventional nutrition education cannot be maintained and could lead to decreased mothers' knowledge. This study is aimed at analyzing the effectiveness of nutrition education using online digital platforms (WhatsApp) to improve a mother's behavior in providing nutritious complementary food based on the theory of planned behavior approach. This was a quasiexperiment with one pretest and posttest design group in the form of education and counselling. Ten educational sessions were developed to improve one or more TPB constructs. Media used for education are PowerPoint, text description, posters, and video tutorials; it is implemented by sending materials through the WhatsApp application. Using 80% power, the sample size was calculated for 155 subjects. Subjects were recruited through the accidental sampling method. Data was collected by the online method using a validated open-ended self-developed questionnaire for knowledge, while attitude, subjective norms, intention, and self-efficacy were measured using a Likert-scale questionnaire, where participants rated the strength of their belief that they could engage in a specific task. The paired t-test was used to analyze the difference in outcomes measured. The response rate of this study was accounted for at 77.5%. The mean age of mothers was 28.2 years old; most of them were university graduates (80.2%) and working as private sector workers (40.0%). The average child's age was 6.6 months old. 78.2% of children were exclusively breastfed. Our study revealed that 10 sessions of nutrition education and counselling covered over 8 days increased the mother's knowledge (60.0 ± 15.5 vs. 80.3 ± 15.0, respectively, before and after education; p < 0.005) and resulted in psychological changes including mother's attitude (64.3 ± 4.9 vs. 65.8 ± 3.9), subjective norm (3.76 ± 0.9 vs. 3.87 ± 1.0), perceived behavioral control (3.78 ± 0.9 vs. 4.12 ± 0.12), self-efficacy (63.3 ± 22.5 vs. 77.5 ± 19.2), and intention toward giving nutritious complementary feeding (4.11 ± 1.0 vs. 4.30 ± 0.9; p < 0.005). WhatsApp nutrition education proved to be effective in improving the mother's knowledge and behavior in providing nutritious complementary food; thus, it has potential for use. In the future, the Ministry of Health from the district to the national level could implement this type of education as an alternative of conventional nutrition education through scheduled classes.
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Stern J, Funkquist EL, Grandahl M. The association between early introduction of tiny tastings of solid foods and duration of breastfeeding. Int Breastfeed J 2023; 18:4. [PMID: 36647140 PMCID: PMC9843836 DOI: 10.1186/s13006-023-00544-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Conflicting advice and non-evidence-based recommendations have a negative effect on breastfeeding. Since 2011, the National Food Agency in Sweden has informed parents that they can introduce tiny tastings (1 mL of solid food, i.e. other sources of nutrition than breastmilk/formula) to infants from four months of age. It is unknown how national recommendations, which differ from the Word Health Organisation's recommendation, affect breastfeeding. We hypothesised that introduction of tiny tastings of solid foods would shorten the duration of continued breastfeeding. METHODS This retrospective study utilises data from the longitudinal 'Swedish Pregnancy Planning Study', in which mothers were recruited at antenatal clinics on a national level. The participants completed three questionnaires up to one year after birth (n = 1,251). Linear regression models were used to analyse the association between the introduction of solid foods and the duration of breastfeeding. RESULTS As hypothesised, introduction of tiny tastings shortened the duration of continued breastfeeding. Half of all infants (48%) were fed with tiny tastings already in the fourth month. The correlation analysis showed that the earlier the infants started with tiny tastings, the earlier they ate larger amounts of solid food. In a multivariate linear regression analysis, five factors were identified as having a negative effect on the duration of breastfeeding: low infant age upon introduction of tiny tastings, low maternal age, low level of maternal education, high maternal BMI and twin birth. CONCLUSIONS Early introduction of tiny tastings of solid foods shortened the duration of breastfeeding. It is difficult to influence most conditions that affect breastfeeding, for example, the mother's educational level, BMI, age and if she has given birth to twins. In contrast, national guidelines can always be updated. Recommendations from the Swedish authorities should adhere to the WHO's recommendation, which states exclusive breastfeeding for six months and continued breastfeeding for at least two years or longer.
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Affiliation(s)
- Jenny Stern
- grid.8993.b0000 0004 1936 9457Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden ,grid.445308.e0000 0004 0460 3941Department of Health Promoting Science, Sophiahemmet University, 114 28 Stockholm, Sweden
| | - Eva-Lotta Funkquist
- grid.8993.b0000 0004 1936 9457Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Maria Grandahl
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden.
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Ramos-Garcia V, Ten-Doménech I, Moreno-Giménez A, Campos-Berga L, Parra-Llorca A, Ramón-Beltrán A, Vaya MJ, Mohareb F, Molitor C, Refinetti P, Silva A, Rodrigues LA, Rezzi S, Hodgson ACC, Canarelli S, Bathrellou E, Mamalaki E, Karipidou M, Poulimeneas D, Yannakoulia M, Akhgar CK, Schwaighofer A, Lendl B, Karrer J, Migliorelli D, Generelli S, Gormaz M, Vasileiadis M, Kuligowski J, Vento M. Fact-based nutrition for infants and lactating mothers-The NUTRISHIELD study. Front Pediatr 2023; 11:1130179. [PMID: 37144153 PMCID: PMC10151649 DOI: 10.3389/fped.2023.1130179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
Background Human milk (HM) is the ideal source of nutrients for infants. Its composition is highly variable according to the infant's needs. When not enough own mother's milk (OMM) is available, the administration of pasteurized donor human milk (DHM) is considered a suitable alternative for preterm infants. This study protocol describes the NUTRISHIELD clinical study. The main objective of this study is to compare the % weight gain/month in preterm and term infants exclusively receiving either OMM or DHM. Other secondary aims comprise the evaluation of the influence of diet, lifestyle habits, psychological stress, and pasteurization on the milk composition, and how it modulates infant's growth, health, and development. Methods and design NUTRISHIELD is a prospective mother-infant birth cohort in the Spanish-Mediterranean area including three groups: preterm infants <32 weeks of gestation (i) exclusively receiving (i.e., >80% of total intake) OMM, and (ii) exclusively receiving DHM, and (iii) term infants exclusively receiving OMM, as well as their mothers. Biological samples and nutritional, clinical, and anthropometric characteristics are collected at six time points covering the period from birth and until six months of infant's age. The genotype, metabolome, and microbiota as well as the HM composition are characterized. Portable sensor prototypes for the analysis of HM and urine are benchmarked. Additionally, maternal psychosocial status is measured at the beginning of the study and at month six. Mother-infant postpartum bonding and parental stress are also examined. At six months, infant neurodevelopment scales are applied. Mother's concerns and attitudes to breastfeeding are registered through a specific questionnaire. Discussion NUTRISHIELD provides an in-depth longitudinal study of the mother-infant-microbiota triad combining multiple biological matrices, newly developed analytical methods, and ad-hoc designed sensor prototypes with a wide range of clinical outcome measures. Data obtained from this study will be used to train a machine-learning algorithm for providing dietary advice to lactating mothers and will be implemented in a user-friendly platform based on a combination of user-provided information and biomarker analysis. A better understanding of the factors affecting milk's composition, together with the health implications for infants plays an important role in developing improved strategies of nutraceutical management in infant care. Clinical trial registration https://register.clinicaltrials.gov, identifier: NCT05646940.
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Affiliation(s)
| | - Isabel Ten-Doménech
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Alba Moreno-Giménez
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Laura Campos-Berga
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Anna Parra-Llorca
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Amparo Ramón-Beltrán
- Division of Neonatology, University & Polytechnic Hospital La Fe (HULAFE), Valencia, Spain
| | - María J. Vaya
- Blood Transfusion Center from the Valencian Community, Valencia, Spain
| | - Fady Mohareb
- The Bioinformatics Group, Cranfield Soil and Agrifood Institute, Cranfield University, Bedford, United Kingdom
| | - Corentin Molitor
- The Bioinformatics Group, Cranfield Soil and Agrifood Institute, Cranfield University, Bedford, United Kingdom
| | | | | | | | - Serge Rezzi
- Swiss Nutrition and Health Foundation, Epalinges, Switzerland
| | | | | | - Eirini Bathrellou
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Eirini Mamalaki
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Melina Karipidou
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Dimitrios Poulimeneas
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Christopher K. Akhgar
- Research Division of Environmental Analytics, Process Analytics and Sensors, Institute of Chemical Technologies and Analytics, Technische Universität Wien, Vienna, Austria
| | - Andreas Schwaighofer
- Research Division of Environmental Analytics, Process Analytics and Sensors, Institute of Chemical Technologies and Analytics, Technische Universität Wien, Vienna, Austria
| | - Bernhard Lendl
- Research Division of Environmental Analytics, Process Analytics and Sensors, Institute of Chemical Technologies and Analytics, Technische Universität Wien, Vienna, Austria
| | | | - Davide Migliorelli
- Swiss Center for Electronics and Microtechnology (CSEM), Landquart, Suiza
| | - Silvia Generelli
- Swiss Center for Electronics and Microtechnology (CSEM), Landquart, Suiza
| | - María Gormaz
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Division of Neonatology, University & Polytechnic Hospital La Fe (HULAFE), Valencia, Spain
| | | | - Julia Kuligowski
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Correspondence: Julia Kuligowski
| | - Máximo Vento
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Division of Neonatology, University & Polytechnic Hospital La Fe (HULAFE), Valencia, Spain
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Shaw V, Anderson C, Desloovere A, Greenbaum LA, Haffner D, Nelms CL, Paglialonga F, Polderman N, Qizalbash L, Renken-Terhaerdt J, Stabouli S, Tuokkola J, Vande Walle J, Warady BA, Shroff R. Nutritional management of the infant with chronic kidney disease stages 2-5 and on dialysis. Pediatr Nephrol 2023; 38:87-103. [PMID: 35378603 PMCID: PMC9747855 DOI: 10.1007/s00467-022-05529-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 01/10/2023]
Abstract
The nutritional management of children with chronic kidney disease (CKD) is of prime importance in meeting the challenge of maintaining normal growth and development in this population. The objective of this review is to integrate the Pediatric Renal Nutrition Taskforce clinical practice recommendations for children with CKD stages 2-5 and on dialysis, as they relate to the infant from full term birth up to 1 year of age, for healthcare professionals, including dietitians, physicians, and nurses. It addresses nutritional assessment, energy and protein requirements, delivery of the nutritional prescription, and necessary dietary modifications in the case of abnormal serum levels of calcium, phosphate, and potassium. We focus on the particular nutritional needs of infants with CKD for whom dietary recommendations for energy and protein, based on body weight, are higher compared with children over 1 year of age in order to support both linear and brain growth, which are normally maximal in the first 6 months of life. Attention to nutrition during infancy is important given that growth is predominantly nutrition dependent in the infantile phase and the growth of infants is acutely impaired by disruption to their nutritional intake, particularly during the first 6 months. Inadequate nutritional intake can result in the failure to achieve full adult height potential and an increased risk for abnormal neurodevelopment. We strongly suggest that physicians work closely with pediatric renal dietitians to ensure that the infant with CKD receives the best possible nutritional management to optimize their growth and development.
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Affiliation(s)
- Vanessa Shaw
- University College London Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Caroline Anderson
- grid.430506.40000 0004 0465 4079University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - An Desloovere
- grid.410566.00000 0004 0626 3303University Hospital Ghent, Ghent, Belgium
| | | | - Dieter Haffner
- grid.10423.340000 0000 9529 9877Children’s Hospital, Hannover Medical School, Hannover, Germany
| | | | - Fabio Paglialonga
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nonnie Polderman
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital, Vancouver, Canada
| | - Leila Qizalbash
- grid.459561.a0000 0004 4904 7256Great North Children’s Hospital, Newcastle upon Tyne, UK
| | - José Renken-Terhaerdt
- grid.417100.30000 0004 0620 3132Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stella Stabouli
- grid.4793.900000001094570051st Department of Pediatrics, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Jetta Tuokkola
- grid.7737.40000 0004 0410 2071Children’s Hospital and Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johan Vande Walle
- grid.410566.00000 0004 0626 3303University Hospital Ghent, Ghent, Belgium
| | - Bradley A. Warady
- grid.239559.10000 0004 0415 5050Children’s Mercy Kansas City, Kansas City, MO USA
| | - Rukshana Shroff
- grid.83440.3b0000000121901201University College London Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
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Jiravisitkul P, Thonginnetra S, Kasemlawan N, Suntharayuth T. Supporting factors and structural barriers in the continuity of breastfeeding in the hospital workplace. Int Breastfeed J 2022; 17:87. [PMID: 36536399 PMCID: PMC9761035 DOI: 10.1186/s13006-022-00533-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The World Health Organization recommends that babies should receive exclusive breastfeeding (EBF) for six months, and mothers should be encouraged to breastfeed until their infant is aged two years or older. The breastfeeding rate in Thailand is currently much lower than the target. One critical factor is lactating mothers returning to work, especially in a hospital workplace with high job stress. In this study, we aimed to identify supporting factors and obstacles to sustaining breastfeeding in hospital-type workplaces. METHODS We conducted a mixed methods study between February 2021 and August 2021 at Chulabhorn Hospital, Thailand. Quantitative data were collected using questionnaires, and qualitative data were gathered in a focus group discussion among purposefully chosen participants, including mothers with both successful and unsuccessful continuation of breastfeeding after returning to work. We conducted multivariate analysis and thematic analysis in quantitative and qualitative data analysis, respectively. RESULTS Questionnaires were completed by 65 permanent employees of the hospital, and seven of these participated in focus group discussion. The rate of exclusive breastfeeding from birth to six months was sixty six percent, and was measured by the responses from questionnaires, which defined as a practice whereby the infants receive only breastmilk without mixing it with other food. Seventy-seven percent of participants were continuing to breastfeed when they returned to work, with 24% (12/50) having to stop after three months. Factors associated with exclusive breastfeeding was caesarean delivery (OR 7.9; 95% CI 2.00, 31.08). Additionally, childcare at the workplace and the attitude of colleagues were found to be supporting factors for sustaining breastfeeding. Barriers included inadequate private facilities (location and equipment), lack of a breastfeeding break, workload, and inconvenient uniform. CONCLUSIONS Effort is needed to sustain breastfeeding after maternal return to work. Our findings are crucial in determining how best to support nursing mothers in breastfeeding after returning to work, particularly during the ongoing COVID-19 pandemic. A breastfeeding-friendly policy with clear operating guidelines in the workplace is critical to sustaining breastfeeding. Learning from others who have had a positive experience will ensure that all breastfeeding women are better supported in the workplace in future.
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Affiliation(s)
- Paveewan Jiravisitkul
- Department of Pediatrics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Saraiorn Thonginnetra
- Department of Pediatrics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Naruporn Kasemlawan
- Department of Pediatrics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Thitiphong Suntharayuth
- grid.512982.50000 0004 7598 2416Data Management Unit, Centre of Learning and Research in Celebration of HRH Princess Chulabhorn’s 60th Birthday Anniversary, Chulabhorn Royal Academy, Bangkok, Thailand
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Maria A, Mukherjee R, Upadhyay S, Pratima K, Bandyopadhyay T, Gupta R, Dubey B, Sharma A, Mall PK, Sahoo M, Pathak KK, Pawar P, Mohapatra A. Barriers and enablers of breastfeeding in mother-newborn dyads in institutional settings during the COVID-19 pandemic: A qualitative study across seven government hospitals of Delhi, India. Front Nutr 2022; 9:1052340. [PMID: 36570141 PMCID: PMC9773092 DOI: 10.3389/fnut.2022.1052340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/10/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction The COVID-19 pandemic disrupted newborn care and breastfeeding practices across most healthcare facilities. We undertook this study to explore the barriers and enablers for newborn care and breastfeeding practices in hospitals in Delhi, India for recently delivered mother (RDM)-newborn dyads during the first wave of the COVID-19 pandemic (2020) and inductively design a "pathway of impaction" for informing mitigatory initiatives during the current and future pandemics, at least in the initial months. Materials and methods We used an exploratory descriptive design (qualitative research method) and collected information from seven leading public health facilities in Delhi, India. We conducted separate interviews with the head and senior faculty from the Departments of Pediatrics/Neonatology (n = 12) and Obstetrics (n = 7), resident doctors (n = 14), nurses (labor room/maternity ward; n = 13), and RDMs (n = 45) across three profiles: (a) COVID-19-negative RDM with healthy newborn (n = 18), (b) COVID-19-positive RDM with healthy newborn (n = 19), and (c) COVID-19 positive RDM with sick newborn needing intensive care (n = 8) along with their care-giving family members (n = 39). We analyzed the data using grounded theory as the method and phenomenology as the philosophy of our research. Results Anxiety among clients and providers, evolving evidence and advisories, separation of the COVID-positive RDM from her newborn at birth, providers' tendency to minimize contact duration and frequency with COVID-positive mothers, compromised counseling on breastfeeding, logistic difficulties in expression and transportation of COVID-positive mother's milk to her baby in the nursery, COVID restrictions, staff shortage and unavailable family support in wards and nursery, and inadequate infrastructure were identified as major barriers. Keeping the RDM-newborn together, harmonization of standard operating procedures between professional associations and within and between departments, strategic mobilization of resources, optimization of human resources, strengthening client-provider interaction, risk triaging, leveraging technology, and leadership-in-crisis-situations were notable enablers. Conclusion The separation of the RDM and newborn led to a cascade of disruptions to newborn care and breastfeeding practices in the study institutions. Separating the newborn from the mother should be avoided during public health emergencies unless there is robust evidence favoring the same; routine institutional practices should be family centered.
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Affiliation(s)
- Arti Maria
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India,*Correspondence: Arti Maria
| | - Ritika Mukherjee
- Generating Research Insights for Development (GRID) Council, Executive Office, Noida, Uttar Pradesh, India
| | - Swati Upadhyay
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Kumari Pratima
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rachita Gupta
- WHO Country Office for India, Nutrition, R.K. Khanna Stadium, Safdarjung Enclave, New Delhi, India
| | - Bhawna Dubey
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Abhinav Sharma
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Pranaya Kumar Mall
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Manaswinee Sahoo
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Keshav Kumar Pathak
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Priyanka Pawar
- Generating Research Insights for Development (GRID) Council, Executive Office, Noida, Uttar Pradesh, India
| | - Archisman Mohapatra
- Generating Research Insights for Development (GRID) Council, Executive Office, Noida, Uttar Pradesh, India,Archisman Mohapatra
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